• Sprains and Strains

  • Sprains are injuries to ligaments, the "bands" that hold joints together. Sprains typically occur when the joint twists or turns beyond its normal range of movement, causing the ligaments to stretch beyond their normal length. If the force is too strong, the ligaments may tear.

    Sprains can range from mild to severe, depending on how badly the ligament  is damaged or how many ligaments are injured. An ankle sprain, for example, is given a grade from 1 to 3 depending on the degree (laxity) of ligaments damaged. A grade 1 sprain is mild, grade 2 is moderate, and grade 3 is severe.

    Strains are injuries to muscles.  Muscles move your joints and can be injured if overworked by repetitive activity, or by overloading the muscles' strength and power.  Muscle strains can also be graded on mild to severe classifications depending on the percentage and severity of muscle micro tears.   A mild strain describes micro tears to a small percentage of the muscle body, while a severe strain may include tears to the majority of the muscle fibers.  A severe muscle strain needs to be treated carefully as they can lead to tendon ruptures. 

    Sprains/ Strains can also be classified as acute, chronic, or recurrent:

    • An acute sprain/ strain occurred recently—usually within the past few weeks—and is in an active stage of healing.
    • chronic sprain/ strain continues to cause symptoms beyond the expected time for normal healing.
    • recurrent sprain/ strain occurs easily and frequently, usually with only minimal force.

    With acute sprains/ strains, you may have:

    • Pain
    • Swelling
    • Inability to bear weight or lift weight

    With most sprains and strains, you feel pain right away at the site of the ligament or muscle tear. Often the joint or muscle starts to swell immediately and may bruise. The area usually is tender to the touch and, when you move, it hurts.

    In more severe cases, you may hear or feel something tear, along with a "pop" or "snap." You probably have extreme pain at first and are not able to walk or even put weight on your joint or extremity. Usually, the more pain and swelling you have, the more severe your injury is, and the longer it will take to heal.

    Your physical or occupational therapist will perform a full evaluation. Manual tests are used to determine how unstable your joint is or how severe your muscle strain may be. The therapist also will decide whether further tests are required or whether consultation with another health care provider is necessary. In some cases, x-rays might be needed to determine whether there is a broken bone. Occasionally, with severe sprains and strains, magnetic resonance imaging (MRI) may be ordered to determine the extent of the damage.

    How Can a Physical Therapist Help?

    The First 24 to 48 Hours

    For the first 24 to 48 hours after injury, sprains/ strains usually are treated by immobilizing, resting, and 10-minute ice treatments, and elevation to control swelling. Your therapist will decide if you should use crutches, cane, or splint to protect your joint while it is healing.

    Your therapist will design a specific treatment program for you to follow at home to help speed your recovery. Some injuries may require therapy treatments to help relieve swelling and pain, such skilled hand movements called manual therapy, special exercises, ice or heat treatments, kinesiotape, and/ or electrical stimulation. More severe cases may require a special brace or splint to provide extra support.

    As You Start to Recover

    Your therapist's overall goal is to return you to the roles you perform in the home, at work, and in the community. Without proper rehabilitation, serious problems—such as decreased movement, chronic pain, swelling, and joint instability (too much movement)—could arise, severely limiting your ability to do your usual activities.

    Your physical or occupational therapist will select from treatments including:

    Range-of-motion exercises. Swelling and pain can result in limited mobility of your joint. Your therapist teaches you how to do safe and effective exercises to restore full movement to your affected joints and muscles.

    Muscle-strengthening exercises.   Muscle weakness may cause long-term instability of the joint and recurring injuries. Your therapist will determine which strengthening exercises are right for you based on the severity of your injury and will progress you depending on where you are in your recovery.

    Body awareness and balance training. Specialized training exercises help your muscles "learn" to respond to changes in your environment, such as uneven or unstable surfaces. When you are able to put full weight through your joint without pain, your  therapist may prescribe these exercises to help you return to your normal activities. For instance, your physical therapist might teach you how to do this: with or without your eyes closed, stand on one leg or stand on a wobble board to challenge the muscles around your ankle.

    Functional training. When you can walk or move your joint freely without pain, your physical or occupational therapist may begin progressing your treatment program to include activities that you were doing before your injury, such as walking in your neighborhood, jogging, hopping, or modified running. This program will be based on your therapist's examination of your joint and muscles, on your goals, and on your activity level and general health.

    Activity-specific training. Depending on the requirements of your job or the type of sports you play, you might need additional rehabilitation that is tailored for your job or sport and the demands that it places on your body. Your therapist will develop a program that takes all of these demands—as well as your specific injury—into account.

    Real Life Experiences

    You're in a hurry but need to stop to pick up something from the store on your way home. While you rush out of the store, you don't notice the curb and twist your ankle. You don't fall, but you immediately have some pain in your ankle. By the time you get home, your ankle still hurts, and you think it might be starting to swell a little.

    What do you do next?

    Immediate first aid for an ankle injury includes "RICE":

    • Rest
    • Ice
    • Compression
    • Elevation

    If you are unable to walk without pain, you might need crutches or another type of assistance. Your physical therapist will perform a full examination of your ankle to determine whether additional tests or referral to another health care provider is necessary. In most cases of ankle sprain, the therapist will manage your care through your full recovery.

    This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.