Information

Sprains and strains are a very common type of injury that affect the muscles and ligaments. Ligaments are strong bands of tissue around joints that connect one bone to another. They help to keep the bones together and stable.

Symptoms of sprains and strains include:

• pain
• swelling and inflammation
• loss of movement in the affected body part

 

Sprains

A sprain occurs when one or more of your ligaments have been stretched, twisted, or torn, usually as a result of excessive force being applied to a joint. The most common locations for a sprain to occur are:

• the knee – which can become strained when a person turns quickly during sports or other physical activities
• the ankle – which can become strained when walking or running on an uneven surface
• the wrist – which can become strained when a person falls onto their hand
• the thumb – which can become strained during intense and repetitive physical activity, such as playing a racquet sport

 

Strains

A strain occurs when the muscle fibres stretch or tear. They usually occur for one of two reasons:

• when the muscle has been stretched beyond its limits
• when the muscle has been forced to contract (shorten too quickly)

 

Strains can develop as the result of an accident, or during physical or sporting activities, such as running or playing
football. The most common types of strains are:

• hamstring strains – the hamstrings are muscles that run down the back of the leg and are connected to the hip and knee joints
• gastrocnemius and soleus strains – the gastrocnemius and soleus are the medical name for the muscles of the calf
• quadriceps strains – the quadriceps are muscles located at the front of the thigh
• lumbar strains – the lumbar muscles are found in the lower back

 

Most mild to moderate sprains and strains can be treated at home using:

• a self-care technique called PRICE therapy, and
• by avoiding HARM

 

These are described in more detail below.

 

PRICE therapy

PRICE stands for protection, rest, ice, compression and elevation. Advice relating to each of these areas is outlined below.

• Protection – protect the injured area from further injury – for example, by using a support or, in the case of an ankle injury, wearing shoes that enclose and support your feet, such as lace-ups.
• Rest – stop the activity that caused the injury, and rest the injured joint or muscle. Avoid activity for the first 48 to 72 hours after injuring yourself. Your GP may recommend that you use crutches.
• Ice – for the first 48 to 72 hours after the injury, apply ice wrapped in a damp towel to the injured area for 15 to 20 minutes every two to three hours during the day. Do not leave the ice on while you are asleep, and do not allow the ice to touch your skin directly because it could cause a cold burn.
• Compression – compress or bandage the injured area to limit any swelling and movement that could damage it further. You can use a crepe bandage, a simple elastic bandage, or an elasticated tubular bandage. It should be wrapped snugly around the affected area but it should not be too tight. Remove the bandage before you go to
  sleep.
• Elevation – keep the injured area raised and supported on a pillow to help reduce the swelling. If your leg is injured, avoid having long periods of time where your leg is not raised.

 

Avoiding HARM

For the first 72 hours after a sprain or muscle strain you should avoid HARM. This means that you should avoid:

• Heat – such as hot baths, saunas or heat packs (applying a controlled amount of heat to affected joints)
• Alcohol – drinking alcohol will increase bleeding and swelling and decrease healing
• Running – or any other form of exercise that could cause more damage
• Massage – which may increase bleeding and swelling

 

When to seek medical help

You should visit your GP or another healthcare professional if you have a sprain or strain and:

• you have severe pain and cannot put any weight on the injured joint or muscle
• the injured area looks crooked or has lumps or bumps (other than swelling) that are not usually present
• you cannot move the injured joint
• the limb gives way when you try to use the joint
• you have numbness in any part of the injured area
• the pain has not improved after four days of self-treatment
• your symptoms get worse, such as increased pain or swelling

 

Moving sprained joints

Most healthcare professionals recommend that you should not stop using a sprained joint because the injury will heal quicker if you begin to move the joint as soon as you are able to. Your GP will be able to teach you a range of exercises that will help you to improve the function of the joint.

An exception to the above advice about immobilisation may be made in cases of severe ankle sprains. Research conducted in 2009 found that people whose ankle joint was immobilised for 10 days with a cast placed under their knee, recovered normal ankle function more quickly than those who were treated using exercise soon after the injury occurred.

 

Immobilising strained muscles

The advice for muscle strains is different. For the first few days after the injury you are advised to immobilise your injured
muscle and keep it still. The length of time that you should keep your muscle immobile will depend on how severe your injury is.

The aim of immobilising the muscle is to allow it to start healing so that you can move it without tearing or pulling it again in the same place. After a few days you will probably be advised to start using the muscle again.

 

Treating pain

If you experience pain from a strain or sprain, paracetamol is the first type of painkiller that will usually be recommended. If paracetamol does not help to relieve your pain, a stronger painkiller, such as codeine which is only available on
prescription, may be required.

Oral non-steroidal anti-inflammatory drugs (NSAIDs) can also help to reduce swelling and inflammation. However, NSAIDs should only be considered for use 48 hours after the injury has occurred because if they are used before this time they may adversely affect the healing process. Ibuprofen is not recommended if you have a history of asthma or kidney disease, or if you have, or have had in the past, stomach problems such as a peptic ulcer.

If your pain is severe, your GP may prescribe you a stronger painkiller, such as codeine, to be used alongside paracetamol. Codeine can cause drowsiness and it is advisable not to drink alcohol when you are taking it.

Your GP may also prescribe an NSAID cream or gel, such as ibuprofen or ketoprofen, to help treat pain. You should gently
apply the cream or gel to the injured area and wash your hands immediately afterwards.

Ketoprofen can make your skin sensitive to light (photophobia). Avoid exposing areas of your skin to which you have applied cream or gel to direct sunlight or artificial sources of light, such as sunlamps or sun beds.

 

Follow up

If you have a sprain or strain, your GP may ask to see you again a few days after your initial diagnosis to assess how well your injury is healing and whether any further treatment is required.

 

Recovery

Following a sprain or a strain, the length of time that it will take for you to recover will depend on the severity of the injury.

Depending on the severity of your injury, after an ankle sprain you will probably be able to walk one to two weeks after the injury. You may be able to use your ankle fully after six to eight weeks and you will probably be able to return to sporting activities after eight to 12 weeks. In cases of muscle strains, the time it can take to return to sporting activities can range widely, from two weeks to six months.

 

Adapted from NHS Choices.

 

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