sprains and strains

Sprains and strains are common injuries. Their symptoms are usually graded according to how mild or severe they are. X-rays are not usually needed to diagnose a sprain or a strain.

What is a sprain?

A sprain occurs when one or more of your ligaments have been stretched, twisted or torn. Ligaments are strong bands of tissue around joints, which connect one bone to another, and help to keep your bones together and stable.

Sprains often occur in ligaments around a joint, such as your ankle or your knee. However, the joint is not dislocated or fractured.

In a minor sprain, some of the fibres within the ligament are stretched. In more serious sprains, the ligament may be torn, either partially or completely.

A damaged ligament can cause inflammation, bruising and pain around the affected joint. The most common locations for sprains are the ankle, knee, thumb and wrist.

What is a strain?

A muscle strain is a stretch or tear of the tissue or fibres that make up your muscles. Sometimes, a strain is referred to as ‘pulling a muscle’.

Most muscle strains happen if a muscle is:

Overstretched.
Forced to tighten (contract) too strongly.

Symptoms of sprains

Common symptoms of a sprain include:

pain around the affected joint
being unable to use the joint normally, or being unable to put weight on it
bruising
tenderness
swelling
inflammation

The swelling from a sprain will often occur soon after the injury. However, the bruising may not show until some time later or may even not show at all. Bruising can appear some distance from the affected joint as blood from the damaged tissues seeps out along the muscles and other structures, around the joint, before coming close to the skin.

Symptoms of strains

The symptoms of muscle strains depend on how severe the injury is.

They can include:

pain in the affected muscle
swelling
bruising

You may have a history of strained or pulled muscles.

When to seek medical help

You should see your GP or another healthcare professional for a sprain or strain if:

you have severe pain and cannot put any weight on the injured joint, or muscle
the injured area looks crooked or has lumps or bumps (other than swelling) that are not normally present
you cannot move the injured joint
the limb gives way when you try to use the joint
you have numbness in any part of the injured area
the pain has not improved after four days of self-treatment

Diagnosing sprains and strains

When making a diagnosis of either a strain, or a sprain, your GP will ask about how you injured yourself. They will probably also ask you about any treatments that you have already tried, as well as any medication that you may be taking which may affect the injury, such as anticoagulants.

Your GP will examine the affected joint, or muscle, in order to assess how severe your injury is. For example, they will check for:

pain, discomfort and tenderness in the injured area
swelling
any lumps and bumps that are not normally present
bruising or bleeding in the joint or muscle

Your GP will also assess:

how much you can move the injured joint or muscle
whether you can put your weight on it

If your sprain is severe, your GP may check whether the ligaments are loose instead of tight. This is sometimes called joint instability, mechanical instability, or ligamentous laxity.

X-rays

Most people with sprains and strains do not need to have X-rays. However, your GP may recommend an X-ray if:

you are unable to put any weight on your ankle, foot or leg
there is tenderness of the bones at specific points on your ankle, foot or leg
you have difficult moving your knee

Your GP may recommend that you have an X-ray if you are over 55 years of age, and you have an acute knee injury.

Treating sprains and strains

Most mild to moderate sprains and strains can be treated at home.

Sprains and strains – using PRICE

Healthcare professionals advise that immediate treatment of sprains and strains should follow PRICE therapy. PRICE stands for protection, rest, ice, compression, and elevation. Advice relating to each of these areas is outlined below.

Protection – protect the injured area from further injury – for example, by using a support or in the case of an ankle injury, wearing shoes that enclose and support your feet, such as lace-ups.
Rest – stop the activity that caused the injury, and rest the injured joint or muscle. Avoid activity for the first 48-72 hours after you injure yourself. Your GP may recommend that you also use crutches.
Ice - for the first 48-72 hours after the injury apply ice wrapped in a damp towel to the injured area for 15-20 minutes every 2-3 hours during the day. Do not leave the ice on while you are asleep and do not allow ice to touch your skin directly as this may cause a cold burn.
Compression – compress or bandage the injured area in order to limit any swelling and movement that could damage it further. You can use a crepe bandage, a simple elastic bandage or an elasticated tubular bandage. It should be wrapped snugly around the affected area but it should not be too tight. You should remove the bandage before you go to sleep.
Elevation – keep the injured area raised and supported on a pillow to help reduce the swelling. If your leg is injured you should avoid long periods of time where your leg is not raised.

Sprains and strains – avoiding HARM

For the first 72 hours after a sprain or muscle strain you should avoid HARM. This means you should avoid:

Heat – such as hot baths, saunas or heat packs (applying a controlled amount of heat to affected joints)
Alcohol - this will increase bleeding and swelling and decreases healing
Running – or any other exercise that could cause more damage
Massage – which may increase bleeding and swelling

Sprains – moving the injured joint

Healthcare professionals advise that you should not immobilise your injured joint and should not stop moving completely. As soon as the pain allows you to move your joint, you should start doing flexibility (range of motion) exercises. Your GP can give you information and advice about the exercises that will be suitable for you.

Strains – immobilising the injured muscle

The advice for muscle strains is different. For the first few days after the injury you are advised to immobilise your injured muscle and keep it still. If your injury is severe your GP may also recommend that you use crutches.

The length of time that you should keep your muscle immobile will depend on how severe your injury is. The aim is to allow the muscle to start healing so that you can move it without tearing or pulling it again in the same place.

After a few days you will probably be advised to start moving and using the muscle.

Treating pain

If you experience pain from a strain or sprain paracetamol is the first type of painkiller that is recommended. If paracetamol does not relieve your pain, a stronger painkiller such as codeine, which is only available on prescription, may be required.

Oral non-steroidal anti-inflammatory drugs (NSAIDs) can also help to reduce swelling and inflammation. However, NSAIDs should only be considered for use 48 hours after the injury has occurred because if they are used before this time they may adversely affect the healing process.

Ibuprofen is not recommended if you have a history of asthma or kidney disease or if you have, or have had in the past, stomach problems such as a peptic ulcer.

If your pain is severe your GP may prescribe you a stronger painkiller, such as codeine, to be used alongside paracetamol. Codeine can cause drowsiness and it is advisable not to drink alcohol when you are taking it.

Your GP may also prescribe an NSAID cream or gel such as ibuprofen or ketoprofen to help treat pain. You should apply the cream or gel gently to the injured area and wash your hands immediately afterwards.

Recovery

Following a sprain or a strain, the length of time that it will take for you to recover will depend on how severe the injury is.

Depending on its severity after an ankle sprain you will probably be able to walk within 1-2 weeks after the injury. You may be able to use your ankle fully after 6-8 weeks and you will probably be able to return to sporting activities after 8-12 weeks.

Follow-up after treatment

If you have strained a muscle, your GP may ask to see you again a few days later, to assess how much your injury has improved.

You should also visit your GP again if:

your sprain, or strain, does not improve as expected – for example, you still find walking difficult
your symptoms get worse, such as increased pain or swelling
you are concerned about your injury