Strains and sprains

Muscle strains and ligament sprains are two common injuries that cause various degrees of pain and swelling.

These injuries respond well to rest, ice, compression, elevation and referral (R.I.C.E.R). This helps protect the injured area and promote a full recovery. If at any time you are worried an injury might be severe, or the pain, swelling or function gets worse and does not improve within two days, visit your doctor to have it checked.

What is the difference between strains and sprains?

Strains – muscle or tendon

A strain occurs when a muscle or tendon (a strong tissue that connects muscle to bone), is overstretched or torn. Strains are usually caused by putting stress on tight or weak muscles. For example, if you have not warmed up enough before explosive stop-start exercise or if your muscles become tired.

If a strain is not allowed to heal properly, or if scar tissue forms, the muscle or tendon can remain weak or painful.

Sprains – ligament

A sprain is a tear in a ligament (a tough fibrous cord that connects a bone to another bone). Sprains are caused by the sudden, forceful twisting of a joint. The extent of the injury will depend on how badly the ligaments are torn or stretched:

  • mild sprain: ligaments are only slightly stretched or torn
  • moderate sprain: ligaments are partly torn
  • severe sprain: ligaments are completely torn.

If a sprain is not allowed to heal properly, there is a good chance the same injury will recur.

What are the symptoms of strains and sprains?

Commons signs and symptoms of strains and sprains include:

  • Pain, tenderness and limited movement. This is your body’s way of preventing you from further injury.
  • Swelling and inflammation. 
  • There might also be some bleeding inside the tissue, which may reveal itself later as a bruise.

Types of strains and sprains

Some sites are more at risk of strains and sprains than others. The commonly affected sites and injuries are discussed below:

Site  Cause of injury
Ankle
  • Ankle injuries are the most common of joint injuries.
  • The most common ankle sprain is when the sole of the foot is turned inwards, injuring the ligaments on the outside of the ankle. This is known as an 'inversion sprain'.
  • Any ankle sprain can put you at risk for another since, when it heals, it leaves the ligament weakened and less flexible for some time.   
Knee
  • Tearing the anterior cruciate ligament (ACL), which joins bones at the knee, is a common sports injury.
  • It can happen when the knee is suddenly twisted with force.
  • This is a serious injury that needs prompt medical attention by a doctor.
  • It may require surgery as well as physical rehabilitation.
Hamstring and calf muscle
  • The hamstring and calf muscles in the back of the leg are easily torn during sprints or jumps, especially if you have not warmed up properly first.
  • There will be pain, swelling, and bleeding in the muscle (bruising).
  • It is important that the muscle heals completely and is at full strength before returning to exercise.
  • Supervised exercises and physiotherapy will help.    
  • If not treated properly, scar tissue can form leaving a weak spot and making future injury likely.

Using R.I.C.E.R to treat strains and sprains

The main aims of treatment is to keep the inflammation and swelling to a minimum, and to be able to use the joint normally again. Most strain and sprain injuries respond well to first aid treatment which involves using R.I.C.E.R: rest, ice, compression, elevation and referral. 

Rest

Stop the activity as soon as you have become injured. Try not to move or load the injured part. Total rest helps prevent further damage.

Ice

Apply ice or a bag of frozen veggies wrapped in a towel to the injury for 20 minutes as soon as possible after the injury. This should be repeated once every two hours over the next two days. Cold will reduce the pain, bleeding and swelling around the injury.

Compression

A firmly applied elasticated bandage will also reduce pain, bleeding and swelling. If there is any numbness or tingling in the fingers or toes, loosen the bandage.

Elevation

Raise the injured part above the level of your heart if possible, resting it on a chair or cushion. This will help reduce bleeding and swelling.

Referral

Within the first two days, if the swelling and pain have not eased and you are unable to use that joint, it is important you visit a doctor to have the injury checked and to get a precise diagnosis. It could be a broken bone or an additional injury to the sprain/strain. Further tests, treatment and physical rehabilitation may need to begin right away.

In addition, avoid HARM for the first 72 hours: Heat, Alcohol, Running (or any exercise), Massage.

Pain relief

You can take over-the-counter pain relievers (analgesics) to treat moderate muscular pain and joint pain. If you are not seeing your doctor immediately, ask your pharmacist for advice about the best type of pain relief for your particular injury. If required, your doctor can also prescribe stronger medications for more severe pain.

Rehabilitation for strains and sprains

Once the pain starts to go away, rehabilitation guided by a doctor or physiotherapist may be needed to gain a full recovery. This may include exercises to:

  • restore normal movement and flexibility
  • improve strength
  • restore coordination and control
  • improve balance
  • maintain overall fitness/healthy body weight
  • rebuild confidence.

A physiotherapist may also use other treatments, such as massage and ultrasound, to assist recovery. It is important, however, to make a 100% recovery before fully testing the injured part in your activity or sport. Your doctor or physiotherapist will advise when you can do this, and it may be that you may need to slowly return to sports and other activities.

Tips to prevent another injury

The following are useful tips on how to avoid injury:

  • improve general strength and fitness to protect joints
  • improve specific sports skills and technique
  • correct any muscle strength imbalances
  • always do a gradual warm-up/jog before exercise
  • follow any specific advice given by your physiotherapist or doctor
  • stop if you feel any pain. 

Learn more

Sprains, strains and bruises St Johns NZ
Sprains v strains – how to know which is which, and what to do about it The NZ Institute of Health and Fitness, 2015
How physio can help muscle sprains
 Physiotherapy New Zealand, 2015
Ankle sprains Podiatry NZ, 2015
Sprains and strains Family Health Diary NZ, 2015

Credits: Health Navigator Editorial Team. Reviewed By: Rebecca Grainger, Hutt Valley DHB (24 February 2017)