A sprain is an injury to the band (ligament) which connects two or more bones to a joint. A sprain is usually caused by the joint being forced suddenly outside its usual range of movement. A severe sprain may look and feel like a break (fracture), and it can be difficult for health professionals to tell the difference between the two. A strain refers to an overstretching and tearing of muscles or tendons. Following a sprain or strain the usual advice is to pay the PRICE (Protection, Rest, Ice, Compression, and Elevation) and avoid HARM (Heat, Alcohol, Running, and Massage) for the first 48-72 hours after injury. Most sprains and strains heal within a few weeks. Note: this leaflet does not advise on how to distinguish what injury you have. For example, it is sometimes difficult to tell if you have a bone fracture, or other more serious injury. Therefore, see a doctor or nurse if you suspect that you have a fracture or other more serious injury. This leaflet assumes you know that you have a sprain or strain (for example, having been told by a doctor or nurse) and nothing more serious. A sprain is an injury to a ligament. Ligaments are strong band-like structures around joints, which attach bones together and give support to joints. A ligament can be injured, usually by being overstretched during a sudden abnormal movement. The ligaments at the side of the ankle are the ones most commonly sprained. A damaged ligament causes inflammation, swelling, and bleeding (which shows as bruising) around the affected joint. Moving of the joint is painful. The picture shows a badly sprained ankle with lots of bruising. For more information, particularly about a sprained ankle, see separate leaflet called Ankle Injury (Sprained or Broken Ankle). The severity of a sprain is graded according to how badly the ligament has been damaged and whether or not the joint has been made unstable. The joint can become unstable when the damaged ligament is no longer able to give it the normal support:
A strain is a non-medical term for a muscle injury. Sometimes it is used to describe the problem of overuse or awkward use of a muscle causing pain in that muscle but usually it refers to an overstretching or tear of muscle fibres (or very rarely of a tendon). A hamstring injury is the most common type of muscle strain. See separate leaflet called Hamstring Injuries. Most strains occur either because the relevant part has been stretched beyond its limits, or it has been forced to pull (contract) too strongly. The severity of a muscle strain is graded into:
Repetitive strain injury is a term used to describe several conditions that can affect the muscles and tendons. It isn't discussed here. See separate leaflet called Repetitive Strain Injury. Tendinopathy and tenosynovitis are other types of tendon injury. See separate leaflet called Tendinopathy and Tenosynovitis (Tendinosis). The main aims of treatment are:
Usually, the damaged ligament or muscle heals by itself over time. Some scar tissue may be produced where there has been a tearing of tissues. The usual initial treatment is described as paying the PRICE (Protect, Rest, Ice, Compression, and Elevation), together with avoiding HARM (Heat, Alcohol, Running, and Massage). These are commonly advised for the first 48-72 hours after a sprain or strain. This treatment must be balanced with early controlled use of the affected part of the body. This helps to keep the strength of the muscles and flexibility in the joints. Painkillers may be needed. Pay the PRICE
That is, avoid:
For more information on using ice for treating pain and swelling, see separate leaflet called Heat and Ice Treatment for Pain. Other treatmentsYour healthcare professional will advise. The advice may typically include:
Extra treatment may be needed for severe sprains (where the ligaments are badly torn (ruptured) or the joint is unstable). There is some evidence that these types of sprain may heal more quickly if treated with a short period of immobilisation. This means wearing a brace or a plaster cast for 10 days or so. In some cases, if ligaments are very badly torn or the joint is too unstable, surgery may be advised. Your doctor will assess if this is necessary (but it is not needed in most cases). If the sprain is still very painful six weeks after the original injury, you may be advised to have additional tests on the joint, such as a further X-ray or scan. Sometimes there are torn ligaments or small breaks (fractures) which do not show up when the injury first happens. The joint may initially have been very swollen and small additional areas of damage might have been difficult to detect. Severe strainFor severe strains (badly torn muscles or tendons), surgery is used very rarely - usually only if there is a complete tear in which the muscle is completely torn or has become unattached to the bone (for example, a severe hamstring injury). Muscles are less easy than ligaments to repair surgically because the muscle fibres do not hold stitches easily. You may not need any medication if the injury is mild and you can tolerate the pain. If needed, paracetamol is the safest choice, especially immediately after the injury. Painkiller options include the following: Paracetamol is useful to ease pain. It is best to take paracetamol regularly, for a few days or so, rather than every now and then. An adult dose is two 500 mg tablets, four times a day. If the pain is more severe, a doctor may prescribe stronger painkillers such as codeine, which is more powerful but can make some people drowsy and constipated. Anti-inflammatory painkillersThese medicines are also called non-steroidal anti-inflammatory drugs (NSAIDs). They relieve pain and may also limit inflammation and swelling. In the UK the National Institute for Health and Care Excellence (NICE) does not recommended that they should to be taken for the first 48 hours after an injury. This is partly because some inflammation is a necessary part of the healing process, and partly because they may very slightly increase bleeding. However, the evidence for this is old and not of very good quality. More recent studies suggest the benefits of taking NSAIDs for the first few days of an injury, outweigh the risks. You can buy some types (eg, ibuprofen) at pharmacies, without a prescription. You need a prescription for some others - eg, naproxen. Side-effects sometimes occur. Stomach pain, and bleeding from the stomach, are the most serious. Some people with asthma, high blood pressure, chronic kidney disease, and heart failure may not be able to take anti-inflammatory painkillers. So, check with your doctor or pharmacist before taking them, to make sure they are suitable for you. If you take anti-inflammatory medication, ibuprofen is recommended as the one least likely to cause side-effects. Again, there are various types and brands of topical anti-inflammatory painkillers. You can buy one containing ibuprofen or diclofenac at pharmacies, without a prescription. You need a prescription for the others. There is debate as to how effective rub-on anti-inflammatory painkillers are compared to tablets. Some studies suggest that they may be as good as tablets for treating sprains. Other studies suggest they are no better than an embrocation. However, the amount of the medicine that gets into the bloodstream is much less than with tablets, and there is less risk of side-effects. A person with a sprain or strain is advised to seek medical advice if there is:
You should see a doctor if there is any concern about the injury, or if the injury is severe. In particular, see a doctor if:
It isn't always possible to prevent injury - sometimes it's just bad luck. However, you are less likely to get a sprain or strain when exercising if:
Also by avoiding falls, if possible:
The ankle is the most commonly sprained joint. For information on preventing ankle sprains, see separate leaflet called Ankle Injury (Sprained or Broken Ankle). The hamstrings - muscles at the back of the thigh - are the most common muscles to strain. To read about hamstring injury prevention exercises, see separate leaflet called Hamstring Injuries. |