Sprains, Strains and Tears

SPRAINS

A sprain is an injury to a ligament, the strong bands of tissue that connect a bone to another at a joint. The severity of a sprain can be classified by the amount of tissue tearing, impact on joint stability, pain and swelling.

DEGREES OF SPRAINS

  • First degree (mildest) – little tearing, pain or swelling; joint stability is good.
  • Second degree – broadest range of damage, with moderate instability and moderate to severe pain and swelling.
  • Third degree (most severe) – ligament is completely ruptured; joint is unstable; severe pain and swelling; other tissues are often damaged.

STRAINS

A strain is damage to muscle fibers and to the other fibers that attach the muscle to the bone. Other names for a strain include “torn muscle,” “muscle pull” and “ruptured tendon.”

DEGREES OF STRAINS

  • First degree (mildest) – little tissue tearing; mild tenderness; pain with full range of motion.
  • Second degree – torn muscle or tendontissues; painful, limited motion; possibly some swelling or depression at the spot of the injury.
  • Third degree (most severe) – limited or no movement; pain will be severe at first, but may be painless after the initial injury.

ACUTE TREATMENT

Here are several decisions you must make when you injure yourself, including how serious the injury is and whether you should go to a health care provider. Look for deformities, significant swelling and changes in skin color. If there are deformities, significant swelling or pain, you should immobilize the area and seek medical help. Many fractures will not cause a deformity.

TREATING A SPRAIN OR STRAIN

Management of both sprains and strains follows the PRICE principle.

  • P – Protect from further injury.
  • R – Restrict activity.
  • I – Apply ice.
  • C – Apply Compression.
  • E – Elevate the injured area.

This PRICE principle limits the amount of swelling at the injury and improves the healing process. Splints, pads and crutches will protect a joint or muscle from further injury when appropriately used (usually for more severe sprains or strains). Activity restriction, usually for 48- 72 hours, will allow the healing process to begin. During the activity restriction, gentle movement of the muscle or joint should be started. Ice should be applied for 15 -20 minutes every 60-90 minutes. Compression, such as an elastic bandage, should be kept on between icings. You may want to remove the bandage while sleeping, but keeping it compressed even during the night is best. Elevating the limb will also keep the swelling to a minimum. If you suspect more than a mild injury, cannot put weight on the limb, or it gives way, you should consult with a health care provider.

REHABILITATION

The next stage of rehabilitation begins following the first 48 to 72 hours. The second stage focuses on gentle movement of the muscle or joint, mild resistive exercise, joint position training and continued icing. During this stage, you may gradually return to more strenuous activities, such as strengthening. Pain should remain low during rehabilitation. If pain increases, it usually means you have attempted to do too much. Throughout your recovery you can still maintain an aerobic training program. Options for training include stationary bicycling, swimming, walking or running in the water. If the injury is more than mild sprain or strain, it is best to consult your health care provider.

EXAMPLE: PROGRESSION OF ANKLE REHABILITATION EXERCISES RANGE OF MOTION

  • Towel pull with toes
  • Draw the alphabet with ankle
  • Stretching with towel (advanced)

MILD RESISTIVE EXERCISES (REGAINING STRENGTH)

  • Foot press against a solid object – up, down and side-to-side
  • Tubing exercises in all motions (painfree)
  • Toe raises (advanced)
  • Hops – start forward and back, short hops (advanced)
  • Weights – Heavy tubing or cuff weights (advanced)

JOINT POSITION (REGAINING BALANCE)

  • Standing with eyes closed – partial squats and side-to-side shifts
  • One-legged stand with eyes closed (advanced)

FUNCTIONING RETURN TO SPORT

  • Performing sport-specific exercise such as figure 8 or shuttle runs.

FUNCTIONING RETURN TO SPORT

  • Performing sport-specific exercise such as figure 8 or shuttle runs.

Printed with permission of the American College of Sports Medicine. Copyright © 2011 American College of Sports Medicine. This brochure was created and updated by A. Lynn Millar, Ph.D., PT, FACSM

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