Sprains vs Strains

In this article we’ll take a look at the difference between muscle sprains and strains.

We will also look at:

• The causes and symptoms of sprains and strains
• How to treat sprains and strains
• Tips and tricks to prevent these types of injuries in the future

So let’s start with defining what sprains and strains actually are…

What are Sprains and Strains?

We have all at some stage in our lives damaged our soft tissues, namely our muscles, tendons and ligaments.  We’ve probably all been told by someone it’s either a sprain or a strain.

But how do we actually know which is which?

• A sprain is an overstretching or tearing of a ligament (the tough white tissue which attaches bone to bone and is generally found around joints)
• A strain is an overstretching or tearing of muscle or tendon (the connective tissue which connects muscle to bone)  Other common names for a strain are such things as a torn or pulled muscle or a ruptured tendon.

What Causes Sprains and Strains?

Sprains occur many ways.

The most common causes of sprains are falls (like rolling your ankle on rough ground), excessive twisting or being hit by an object (such as tackle in soccer).  These incidents will cause a joint to move out of its normal range of motion resulting in the overstretching or tearing of a ligament.

Strains can occur over time or suddenly.

Strains that occur over time are also referred to overuse injuries.  They occur due to the continual stressing of a muscle’s fibres and its tendon (like overusing the tendons in the wrist with too much typing)

Strains that occur suddenly (acute) are due to a stretching, twisting or overloading of a muscle and its tendon.  A strain occurring suddenly is generally caused by over stressing or overloading a muscle (such as lifting heavy objects with poor technique and straining a muscle in your back) or stressing a previously injured area (such as sprinting and straining a hamstring that was not fully recovered)

Sprain or Strain, How Can You Tell?

It’s not always immediately obvious whether an injury can be identified as a sprain or a strain or how severe that injury may be, so the following lists some common symptoms of each and their categories of severity.

Sprain Symptoms

A sprain occurs suddenly around a joint and produces symptoms such as:

• Direct pain
• Swelling
• Bruising
• Inability to use or move the joint.

Sprain Categories

A sprain is categorised according to severity.

• 1^st Degree (mild) – very few fibres are torn
• 2^nd Degree (moderate) – a large number of fibres are torn
• 3^rd Degree (severe) – a complete rupture of the muscle or tendon

Strain Symptoms

A strain can occur over time or suddenly and produces symptoms such as:

• Localised pain or tenderness
• Muscle weakness
• Swelling
• Muscle spasms or cramping
• Limited movement

Strain Categories

Similar to sprains, strains are categorised according to severity:

• 1^st Degree (mild) – very few fibres are torn
• 2^nd Degree (moderate) – a large number of fibres are torn
• 3^rd Degree (severe) – a complete rupture of the muscle or tendon

Acute Treatment

Acute (immediate) treatment of sprains and strains is the same initially.  Firstly you need to decide whether further medical advice is needed or not.  Look out for:

• Deformities (something looks out of shape)
• Changes in skin colour
• Large amounts of swelling about the injury site

If any of the above are present then the injury site should be immobilised and medical attention sought after.

If medical attention is not required immediately then the following should take place:

P = Protect from further injury (splints, pads or crutches)

R = Restrict activity, rest (first 48-72 hours)

I  = Apply Ice (every 20mins per hour)

C = Apply Compression (elastic bandage)

E = Elevate injured area (elevate injured area above heart, if possible)

D = Send person for diagnosis (if pain has not subsided after 24 hours)

During this phase stay away from HARMS which increase damage to the injury:

H = Heat (sauna, spa, hot showers etc all increase bleeding)

A = Alcohol (increases swelling)

R = Running (exercising too soon increases bleeding and swelling)

M = Massage (massage or heat rubs increase swelling and bleeding)

S = Stretching (stretching further tears damaged muscle fibres, ligaments or tendons)

Rehabilitation

Although acute injury treatment is similar for sprains and strains, their time to heal is different.  Sprains take longer to heal as they are the result of damage to ligaments.

Ligaments are made up of bundles of dense fibrous connective tissue, and are avascular (without blood vessels) which is why they appear white and take such a long time to heal (e.g.: Achilles tendon rupture).

This is different to a strain, which is muscle and tendon based injury.  As muscles have rich supply of blood and nutrients from capillaries, they can heal much faster.

Tendons also have blood supplied (although in small amounts) via the musculotendinous (between muscle and tendon) and osseotendinous (between bone and tendon) junctions, so tendons also heal quicker than ligaments.

The timeline for rehabilitation also varies depending on the severity of the injury, but as a general guideline the following three stages should be completed as soon as possible, injury permitting.

Stage 1:

First 48-72 hours post injury

• PRICE and No HARMS

Stage 2: 

Post first 48-72 hours

• Gentle muscle / joint movement
• Muscle / joint stability exercises
• Mild resistance exercises followed by icing

Stage 3:

Once movement is pain free

• Gradually return to more strenuous strengthening activities
• Pain should remain low; if it increases, stress is too much on injured area

If you or your personal training clients are unsure at any stage, seek medical advice.

How to Avoid Future Sprains and Strains

To decrease the likelihood of future injuries the following are recommended:

• Always perform a gradual warm-up before exercise and a gradual cool down after exercise
• Stop any exercise if you feel pain!
• Improve general strength and fitness to protect muscles and joints
• Improve specific sports skills and techniques, preparing muscles and joints for the stresses they will be placed under during activity
• Correct any muscle strength imbalances

Understanding the differences between strains and sprains allows us to better understand how these injuries occur as well as how to treat and rehabilitate from them.

It also allows us to write better personal training programs, whether for recovery and rehabilitation from a sprain or strain, or manipulating current training around these injuries.