Sprains and strains are very common injuries that produce symptoms such as swelling, bruising, and pain, but involve different structures within your body.
A sprain involves the joint structures such as the joint capsule or the joint ligaments. Ligaments are the tough bands of connective tissue that join two bones together to form a joint. The most common sprain seen by a physiotherapist is an ankle sprain. The mechanism of injury usually involves the affected joint being forced beyond its normal range of motion, and if the force is too strong, ligament injury will occur. The force involved will determine the grade of ligament injury.
| Severity | Examination Findings | Functional Impairment | Pathophysiology | Treatment |
|---|---|---|---|---|
| Grade 1 | Slight tenderness to touch, minimal swelling | Minimal loss of function | Some small tearing of collagen fibres | Normal weight bearing as tolerated Exercises for strength, stability and range of motion given. Recovery normally 1-4 weeks |
| Grade 2 | Moderate tenderness and welling. Limitation to range of motion and possibility of joint instability | Moderate loss of function, may not be able to fully weight bear. | Complete tears to some collagen fibres - also know as partial tear. | May need splinting to help relieve pain, range of motion exercises. After inflammation has settled, increase strength and proprioception as pain allows. Recovery normally 4-8 weeks. |
| Grade 3 | Severe swelling and tenderness, marked joint instability | Severe loss of function, unable to weight bear, minimal motion available due to pain | Complete tear/rupture of ligament | Needs support in sling/splint/brace. Will require a couple of weeks immobilisation followed by graduated exercises for range of motion, strength and stability. May take up to 6 months to recover from this. |
A strain involves a muscle or its tendon. A tendon is a fibrous cord of tissue that connects muscles to bones. Strains often occur in the lower back muscles, hamstrings and shoulders. The grading of muscle injuries is very similar to that of ligament injuries. Grade 1 - small tear in the muscle, minimal dysfunction, Grade 2 - Partial tearing of muscle fibres, some loss of function, Grade 3 - complete tearing of muscle, marked functional loss.
Initial treatment for both sprains and strains includes rest, ice, compression and elevation Mild sprains and strains can sometimes be successfully treated at home but diagnosis is important to avoid missing more serious injury. Severe sprains and strains sometimes require surgery to repair torn ligaments, muscles or tendons. Your physiotherapist will be able to direct you to another health professional if your injury requires further investigation or even surgery.
