Sprains and Strains Health Article

Definition

A sprain is an injury to ligaments and/or the joint capsule that occurs in response to large stresses. A strain is disruption of the contractile elements in muscle and/or tendon. An easy way to remember the difference between sprain and strain is that strain is spelled with a "t," which can infer the associated word tendon.

Sprains

In a mild sprain, the individual can usually engage in normal activities within three to six weeks. In a moderate sprain, normal activities can usually resume in approximately eight to 12 weeks—ligamentous tissue requires approximately eight to 10 weeks to heal. By the third or fourth week, however, the individual with a moderate sprain will usually have a normal range of motion and be free of pain. Therefore, the key to recovery from a moderate strain is to prevent the patient from returning to normal activity before the ligament heals.

Strains

The prognosis for treating first or second degree strains is good. The major problem is stressing the affected area too soon. Overstressing the affected area too early in recovery may cause the strain to become chronic. A chronic strain could lead to further complications such as muscle spasm and possible myositis.

Causes and symptoms

Both sprains and strains are due to increased demand or large stresses placed on the involved structures, i.e., ligament, muscle, or tendon.

KEY TERMS

Immobilization—To keep a limb or joint free from movement and to maintain position. Movement is stopped by either bracing or casting.

Irritation—Minimal disruption of a structure that may cause bleeding. An irritation can present with minimal swelling and a feeling of discomfort to the individual. Usually, function is not impaired secondary to an irritation. An irritation can progress to a more severe impairment if healing is not allowed to appropriately take place.

Modalities—A term used to describe treatment modes that are applied to the individual. In rehabilitation, a few examples of a modality could be heat, ice, ultrasound, electrical stimulation, and traction.

Range of motion—The amount of motion that a joint has. There is active range of motion and passive range of motion. Active range of motion is the range the joint can traverse under voluntary contraction. The individual moves the limb using their muscle power. Passive range of motion is the range that the joint moves though while either a machine or individual moves the limb. In passive range of motion the limb is usually moved for the individual with no muscle contraction.

Therapeutic exercise—A general term to describe a multitude of exercises, stretching and general rehabilitation. Can include range of motion, resistive exercises such as weight training, postural correction exercises, and exercises that incorporate coordination and balance training.

The prognosis for a complete rupture (severe sprain) varies. Success depends on the management of the injury, and the subsequent level of desired activity. A return to normal activity may require from six months to one year.

Health care team roles

It is appropriate that physicians, nurses, therapists, and other allied health partners be familiar with the prevention and care of sprains and strains. Moreover, nurses and allied health partners should be involved in patient education that focuses on minimizing the risk of over-use injuries.

Prevention

The best prevention for sprains and strains is to have optimal muscular strength, muscular flexibility, and endurance. Appropriate warm-up exercises before an activity may further minimize the potential for injury. Sprains may also be prevented by the use of a brace.

Sprains are caused by excessive stress to a ligament or capsule. Optimal strength, flexibility and endurance help the muscles to accept and distribute forces that might otherwise be placed on the joint. If muscles are weak and not flexible, increased demand placed on the area will need to be absorbed by the ligaments or joint capsule. Increased demand on these structures will put them at greater risk for failure, i.e. tearing. Braces may absorb some of this extra demand. For example, persons wishing to avoid ankle injury may choose to tape their ankle or wear a lacing brace before engaging in activities with injury potential. Persons with prior ankle injuries may utilize an air stirrup.

Surfaces may also play a role in sprains and strains. A controversial example is the comparison of football injuries on natural grass and artificial turf. One study found an increased rate of anterior cruciate ligament sprains in football players playing on artificial turf compared to sprains on natural grass. A less controversial example might be the comparison of a manicured lawn to a field of wild prairie grass. The prairie grass might hide many dips in the field that would be apparent in a manicured lawn. Such a field would provide a greater likelihood of injury due to the unpredictability and unevenness of the surface (there is a greater chance for unexpected excessive forces on a joint).