Sprain or Strain? What’s the Difference?

Sprains occur when ligaments of the body become over-stretched. Ligaments are bands of thick connective tissue that hold two bones together at a joint. Although sprains can occur at any joint, one of the most common area for ligamentous sprains is at the ankle. Most often an ankle sprain occurs when the ankle rolls outward and the ligaments on the outside of the ankle become over-stretched and painful. 77-83% of all sports related ankle injuries are from these lateral ankle sprains, and ankle injuries themselves occur 10-34% of the time when any sports injury occurs.

Depending on the severity of the overstretched ligament, the impact of a sprain can range from a nuisance to debilitating.

Grade I sprains are microscopic to small tears of a ligament, which results in mild pain, swelling and possibly bruising. With Grade I sprains, the joint remains stable.

Grade II sprains are larger, incomplete tears of the ligament. Pain and swelling are generally moderate and bruising typically occurs. Some instability, or looseness in the joint, may be noted with Grade II sprains.

Grade III sprains are complete tears of a ligament and result in significant pain, swelling and bruising, and the joint will feel unstable or loose.

When a ligament pulls away from the bone itself, it results in a small broken bone where the ligament was attached, called an avulsion fracture. When a ligamentous injury occurs, the area is generally tender to touch and may be swollen or bruised. If it is difficult to put weight through the body part after a suspected sprain, an x ray may be indicated to rule out a fracture, or a broken bone.

If the injury is mild, however, initial treatment consists of the acronym RICE.

• REST- Give the injured area a break. In addition to simple rest, a sling or crutches may be used to minimize pressure on the injury.

• ICE- Ice the injured area for approximately 10-15 minutes a few times a day to decrease swelling, pain, and possibly bruising. Monitor the skin for adverse reactions to the ice.

• COMPRESSION- Wearing a compression sock, brace or elastic bandage can assist with swelling control.

• ELEVATION- Elevate the sprained area above the level of your heart to minimize swelling.

Strains, on the other hand, are over-stretch injuries to muscles or tendons (which connect muscles to bones) of the body. Pain, swelling, and inflammation will occur over the area, causing bruising or muscle weakness to occur.

Like sprains, strains can vary in severity from mild injury to a complete tear of the muscle or tendon. When a tendon pulls away from the bone itself, it results in a small broken bone where the ligament was attached, also called an avulsion fracture. When a muscle or tendon injury occurs, the area is generally tender to touch and may be swollen or bruised.

If it is difficult to put weight through the body part after a suspected strain, an x ray may be indicated to rule out a fracture, or a broken bone. Or if pain and weakness occur, an MRI may be indicated to rule out a complete tear. If a complete tear occurs, surgery may be indicated. If the injury is mild, however, initial treatment is the same as for a sprain—Use the acronym “RICE”

What Can You Do About A Sprain or Strain?

If you have experienced a sprain or strain and your symptoms have not resolved after ‘RICE’ treatment, physical therapy may be able to bring relief. As a physical therapist at Penn Therapy & Fitness, the first thing I do when meeting a patient is an evaluation to examine their strength, range of motion and function.

Outpatient physical therapy at Penn Therapy & Fitness focuses on exercise, pain management and education. Once pain and swelling are under control, your physical therapist can work with you to regain range of motion in the affected areas. One technique that is often used is manual therapy, where your physical therapist stretches your joints or muscles.

Once more motion is achieved, your physical therapy program will incorporate an appropriate strengthening program for you. Eccentric, or muscle lengthening/lowering exercises, in particular, have been suggested to improve outcomes with tendon injuries/strains. Concentric, or shortening exercises, are also beneficial in regaining strength. Finally, to return you to your previous activity level, your physical therapy session will incorporate exercise to improve balance, stability and the quality of how you move.

Whether you’re looking to return to the basketball court or simply walking with the assistance of a cane around the block, outpatient physical therapy at Penn Therapy & Fitness can help. To learn more about our services, click here to view a full listing of our locations.

About the Blogger:

Lynne Gramberg, MSPT, OCS, Cert. MDT, ATC, earned her Physical Therapy Master’s degree from Thomas Jefferson University, and her Bachelors of Science degree in Physical Education from Penn State University. She is a board certified orthopedic specialist of the American Physical Therapy Association, Certified in the McKenzie Method of Mechanical Diagnosis and Treatment, and a Certified Graston provider, in addition to being a certified athletic training for over 30 years. As a lifelong resident of Roxborough, she is dedicated to the community and her alma mater, Roxborough High School, where she is on the committee for the Roxborough High School Sports Hall of Fame.