Sprains and Strains
Definitions and Anatomy
| Term | Definition | Typical sites |
|---|---|---|
| Sprain | Stretching and/or tearing of a ligament | Ankle, knee, wrist, thumb |
| Strain | Stretching and/or tearing of muscle fibres and/or tendon | Calf, hamstrings, quadriceps, back |
Key anatomy:
- Ligaments connect bone to bone and stabilise joints
- Tendons connect muscle to bone and transmit muscle force
- Muscles generate movement and may be injured by overstretching or sudden forceful contraction
Common Mechanisms
Sprain
Usually occurs when a joint is forced beyond its normal range of movement, causing ligament injury.
Common examples:
- Ankle inversion injury → lateral ankle sprain
- Ankle eversion injury → medial ankle sprain
- Twisting knee injury → collateral ligament or cruciate ligament injury
- Fall onto an outstretched hand → wrist or thumb ligament injury
Strain
Usually occurs due to excessive stretching or sudden contraction of a muscle-tendon unit.
Common examples:
- Sprinting / sudden acceleration → hamstring strain
- Jumping or pushing off → calf strain
- Lifting or twisting → back strain
Clinical Features
| Feature | Sprain | Strain |
|---|---|---|
| Main structure injured | Ligament | Muscle or tendon |
| Pain location | Usually around a joint | Usually over a muscle belly or tendon |
| Mechanism | Twisting, rolling, forced joint movement | Overstretching, sudden contraction, overuse |
| Swelling / bruising | Common around the joint | May occur over the injured muscle |
| Weakness | May occur due to pain or instability | Common due to muscle injury |
| Instability | May suggest significant ligament injury | Not typical unless associated with tendon rupture |
| Muscle spasm / cramping | Less typical | More typical |
Initial Management
Most simple sprains and strains are managed conservatively.
Early Management: PRICE
Advise on initial PRICE self-management strategies for the first 48-72 hours after injury:
| Component | Meaning |
|---|---|
| Protection | Protect from further injury (e.g. splinting, taping, appropriate footwear) |
| Rest | Avoid activity for the first 48-72 hours |
| Ice | Apply ice wrapped in a damp towel for 15-20 minutes every 2-3 hours during the day
|
| Compression | Use a simple elastic bandage or an elasticated tubular bandage to control swelling (remove before going to sleep) |
| Elevation | Elevate the injured limb above heart level where possible, until the swelling is controlled |
Analgesia
- Paracetamol can be used for pain relief
- Consider topical NSAIDs
- Oral NSAIDs may be considered if appropriate, but avoid or use cautiously in patients with contraindications, e.g. renal disease, peptic ulcer disease, anticoagulation, significant cardiovascular risk, or pregnancy.
Early mobilisation
Patients should be advised to start active mobilisation and flexibility (range of motion) exercises as soon as tolerated without excessive pain.
- Prolonged complete rest may lead to stiffness and delayed functional recovery
Consider referral to physiotherapy if there are ongoing symptoms that are not improving despite self-management strategies