Sprains and strains are terms we commonly use, often interchangeably, as part of our vocabulary but do what really are they? Is there a difference?
Sprains and Strains are terms used to describe the overstretching or tearing of soft tissue. The term sprain is used for when this injury occurs in ligaments and strain is used when this injury happens in muscles and tendons. You will remember from our previous article that ligaments are bands of fibrous tissue that attach bone to bone, whereas tendons attach muscle to bone. The most common location for sprains is in the ankle joint and the most common locations for sprains are the hamstring and the lower back muscles.
Sprains and strains are usually graded to describe the extent of the injury, as well as structures involved. This grading based on the number of fibers involved in the injury and also guides the rehabilitation process.
Grading
Grade I
- Mild overstretching and microscopic tearing of the fibres.
- Less than 5% of fibres are torn.
- There is no loss of strength or function.
Grade II
- More than 5% of fibres are torn, but not a complete tear.
- Partial to significant loss of strength or function.
- Tendons become thinned, irregular or lax.
Grade III
- Complete or full tear of the fibres of the muscle, tendon or ligament.
- Loss of function of the structure
Signs and Symptoms
Grade I
- Mild tenderness, swelling and stiffness.
- Slight bruising or discoloration.
- Minimal impairment: Joint feels stable and one can continue most activities and movements with minimal pain (depending on location of injury).
Grade II
- Moderate pain, swelling, bruising discoloration.
- Area is tender to touch.
- Some joint instability and giving way but overall joint integrity can be maintained.
- Some loss of ROM (Range Of Motion)
- Moderate impairment: Pain and difficulty with most activities.
Grade III
- Audible pop at time of injury.
- Change in the normal outline of the muscle or joint, may have a visible gap or dent.
- Severe swelling and bruising.
- Significant pain often noted.
- Joint is unstable and gives out.
- Significant impairment: Pain and difficulty with movement, movement may be abnormal or sometimes may not even be possible.
Causes
These injuries occur when the load that is placed on the tissues is greater that what they can bear, especially in muscles crossing 2 joints and during excessive eccentric load. This can be through:
- Explosive actions, such as sprinting drills.
- Changes in training load, such as increase intensity, change in terrain such as is common in training camps.
- Lack of flexibility.
- Lack of warm-up.
- Repetitive loads, especially over extended periods of time.
Factors such as age, changes in training regime and even diet, previous history of injury, certain illnesses and medications, as well as fatigue have been shown to increase the chances of getting these injuries.
Diagnosis
Diagnosis is based on the history as well as physical assessment. The assessing professional will then decide on the need for imaging based on this.
X-ray may sometimes me recommended in cases where there’s a need to exclude a fracture or dislocation. Sometimes the tendons pull off and break a piece of bone causing a fracture.
Diagnostic ultrasound and MRI (Magnetic Resonance Imaging) are better methods of imaging for soft tissue. These help see the extent of the injury and inflammation on the area and surrounding tissues too.
Treatment
Pain management and anti-inflammatory management is applicable for all grades, as needed. It is important to note that caution needs to be exercised with anti-inflammatory use and tendon and ligament as these affect the integrity of the fibres.
Grade I
- PRICE (Protection, Rest, Ice, Compression, Elevation): Protection added to the traditional RICE treatment. Protection includes measures such as change in weight-bearing or immobilising the joint where applicable.
- Physiotherapy rehabilitation.
Grade II
- Immobilising with splints or slings.
- Crutches for lower limb injuries, when applicable.
- Physiotherapy rehabilitation.
Grade III
- Surgical reconstruction where possible.
- Physical rehabilitation.
Physiotherapy rehabilitation is tailored according to the specific injuries of each person, from pain and swelling reducing techniques, increasing ROM, to release of spasms and progressive strengthening and functional retraining.
The return to sport occurs is different for each grade of injury according to sport and location of the injury. The athlete will usually return when they have normal strength and ROM without pain, according to the recommendation of the medical professionals involved.
Rehabilitation is a very important step in the treatment of sprains and strains. During rehabilitation not only will the current injury be treated, but also risk factors will need to be addressed and corrections made where needed to reduce chances of recurrence.
