Sprains & strains

Definition

Sprain refers to damage or tearing of ligaments or a joint capsule. Strain refers to damage or tearing of a muscle.

Description

When excessive force is applied to a joint, the ligaments that hold the bones together may be torn or damaged. This results in a sprain, and its seriousness depends on how badly the ligaments are torn. Any ligament can be sprained, but the most frequently injured ligaments are at the ankle, knee, and finger joints.

Strains are tears in the muscle. Sometimes called pulled muscles, they usually occur because a muscle lacks the flexibility, strength, or endurance to perform a certain activity. The majority of strains occur where the muscle meets the tendon, although they may occur in the middle of the muscle belly as well.

Children under age eight are less likely to have sprains than are older people. Children's ligaments are tighter, and their bones are more apt to break before a ligament tears. People who are active in sports suffer more strains and sprains than less active people. Repeated sprains in the same joint make the joint less stable and more prone to future sprains. Muscle strains are also more likely to occur in muscles that have been previously injured.

Causes & symptoms

There are three grades of sprains. Grade I sprains are mild injuries in which there is a stretching or mild tearing of the ligament, yet no joint function is lost. However, there may be tenderness and slight swelling.

Grade II sprains are caused by a partial tear in the ligament. These sprains are characterized by obvious swelling, localized tenderness, pain , joint laxity, difficulty bearing weight if the injury is to a lower extremity, and reduced function of the joint.

Grade III, or third degree, sprains are caused by complete tearing of the ligament. There is severe pain, loss of joint function, widespread swelling, and the inability to bear weight if in the lower extremity. While a Grade III sprain may be very painful when it occurs, it is sometimes not painful after the injury because the ligament fibers have been completely torn and nothing is pulling on them. If this is true, the injury will be accompanied by a significant loss in joint stability.

Strains, like sprains, are also graded in three different categories. Grade I strains are considered mild. They are categorized by some localized swelling with no significant disruption of the muscle tendon unit. Stretching or contraction of the muscle may be painful.

Grade II strains indicate some disruption of the muscle tendon unit. They will often show a loss of strength and limitation in active motion, but the muscle has not been completely disrupted.

Grade III, or third degree, strains indicate a complete rupture in the muscle tendon unit. This injury is likely to be very painful and often the individual will report hearing a loud pop or snap when the injury occurred. The site of injury is often quite visible and there will be a significant defect in the muscle that can be felt with the fingers. A Grade III muscle strain will often have very serious bruising with it as well.

Diagnosis

Grade I sprains and strains are usually self-diagnosed. Grade II and III sprains are often seen by a physician, who may x ray the area to differentiate between a sprain and other serious joint injuries. Since muscles don't show up on x ray, Grade II and III muscle strains are usually diagnosed by physical examination.

Treatment

While the primary problem with sprains and strains is a torn or damaged ligament or muscle fiber, additional complications may develop as a result of swelling and immobilization of the injured area. In order to prevent these complications from worsening, alternative practitioners endorse RICE: Rest, Ice for 48 hours, Compression (wrapping in an elastic bandage), and Elevation of the sprain or strain above the level of the heart.

Nutritional therapists recommend vitamin C and bioflavonoids to supplement a diet high in whole grains, fresh fruits, and vegetables. Anti-inflammatories, such as bromelain (a proteolytic enzyme from pineapples) and turmeric (Curcuma longa ), may also be helpful. The homeopathic remedy Arnica (Arnica montana ) may be used initially for a few days, followed by Rhus tox (Rhus toxicodendron ) for joint-related injuries or Ruta rutagraveolens for muscle-related injuries. Arnica gel or ointment, such as Traumeel, or a homeopathic combination of arnica and other remedies, has also been found effective with certain joint sprains.

Traditional Chinese medicine has been effectively used to treat soft tissue injuries like sprains and strains. Acupuncture is used to treat pain and speed the healing process in the damaged tissues by moving blocked energy from the area. The radiant heat of moxibustion may also be used to speed up the healing response in the damaged tissues.

Specialized forms of massage and soft tissue manipulation may be used by a variety of practitioners. Massage has significant effects in enhancing local circulation, promoting earlier mobility, and speeding the healing response in the damaged tissue. It will most often be used in combination with other approaches, including stretching and range of motion exercises.

Allopathic treatment

Grade I sprains and strains can be treated at home. Basic first aid for sprains consists of RICE (Rest, Ice, Compression, and Elevation). Such over-the-counter pain medication such as acetaminophen (Tylenol) or ibuprofen (Motrin) can be taken for pain.

People with grade II sprains or strains may often be referred to physical therapy. Crutches or splints may be used during the healing process to help maintain stability. Surgery may be required for Grade III sprains or strains as a greater amount of damage will often prevent adequate healing without surgery.

Expected results

Moderate sprains and strains heal within two to four weeks, but it can take months to recover from severe injuries. Until recently, tearing the ligaments of the knee meant the end of an athlete's career. Improved surgical and rehabilitative techniques now offer the possibility of complete recovery. However, once a ligament has been sprained, it may not be as strong as it was before. A muscle that has been strained is also more susceptible to reinjury.

Prevention

Sprains and strains can be prevented by warming up before exercising, using proper form when performing activities and conditioning, being careful not to exercise past the point of fatigue , and taping or bracing certain joints to protect them from injury.

Resources

BOOKS

Benjamin, Ben. Listen to Your Pain. New York: Penguin, 1984.

Burton Goldberg Group. "Sprains." In Alternative Medicine: The Definitive Guide, edited by James Strohecker. Puyallup, WA: Future Medicine Publishing, 1994.

Corrigan, Brian, and G.D. Maitland. Musculoskeletal & Sports Injuries. Oxford: Butterworth–Heinemann, 1994.

Pelletier, Kenneth R. The Best Alternative Medicine. New York: Simon & Schuster, 2000.

"Sprains and strains." In The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. Alexandria, VA: Time–Life Books, 1996.

PERIODICALS

Wexler, Randall K. "The Injured Ankle." American Family Physician 57 (February 1, 1998): 474.

Whitney Lowe