Sprains

This article contains self-care information for the selected condition. If you have questions or need more comprehensive treatment advice, please consult a medical professional.

Sprains are common musculoskeletal conditions. Most cases of sprains can be treated at home. 1 Thus, it is important to have an understanding of these conditions.

A sprain happens due to overstretching or tearing of a ligament. Ligaments are bands of fibrous tissue that connect two or more bones at a joint. Falling, twisting, or getting hit around the area can cause injury to one or more ligaments at the same time.

The severity of sprains depends on the extent of injury (whether the tear is complete or partial), and the number of affected ligaments. Ankle sprain, knee sprain, and wrist sprain are some of the common ligament injuries.

Sprain symptoms may range from pain, swelling, bruising, and inability to move the joints. On the onset of sprain, people may feel a pop or tear when the injury happens. 2 3

Treatment for sprains may involve rest and pain relief medication. Initial treatment consists of resting the injured area, icing it, wearing a bandage to compress the area, and medicine. Surgical intervention may be an option for severe cases. Follow-up treatment might include exercise and physical therapy. 2 3

If you have an injury that could be a strain, try using the free Ada App to find out more about your symptoms.

Injuries affecting ligaments and tendons in the case of sprains occur from either direct or indirect trauma. 1

A sprain can occur when the joint is forced out of its normal position. The manoeuvre can stretch or tear the ligament supporting that joint. That can happen in both upper and lower body parts.

One of the most common locations of sprain is the ankle. Most sprained ankles sprains happen when the foot turns inward. People may develop this when they run, turn, fall, or land on the ankle after a jump.

Other common injuriessites are the knee sprain and sprained wrists. A knee sprain may result from receiving a blow to the knee, falling, or a sudden twist of the joint. People may be more likely to experience wrist sprain if they fall and land on an outstretched hand. 2 3

Read more on repetitive strain injury.

A sprain can happen to anyone. Some people may be at higher risk, including: 4

1. Athletes

• Jumping sports carry a higher risk of foot, knee, and ankle strains and sprains. Some examples are basketball and volleyball
• Gymnastics, tennis, and golf carry a higher risk of hand, wrist, elbow, rotator cuff, and arm strains and sprains.
• Contact sports, such as hockey and football, carry a higher risk of any type of sprains and strains. It includes but is not limited to the fingers, thumbs, toes, and neck.
• Endurance sports (for example, running and triathlon) carry a higher risk of strains from overuse. The commonly affected areas include hips, calves, hamstrings, quads, and other parts of the legs.

1. People with a history of prior sprains or strains,
2. People who are overweight,
3. People who are starting physical activity or exercise programs for the first time,
4. People with neurologic problems,
5. People with balance disorders.

Symptoms of sprains can vary and depend on the severity of the sprain. These may include: 2 3

• pain
• swelling
• bruising
• instability
• loss of the ability to move and use the joint.

Do these symptoms sound familiar? Try Ada to find out more.

To assess the severity of the sprain, medical professionals may check the grade of injury. 2 5

1. First degree (mildest) sprains

A grade I or mild sprain happens when people overstretch or slightly tear ligaments, leading to the following symptoms:

• Minimal pain and swelling.
• Little or no loss of functional ability.
• Slight or no bruising.
• Little trouble putting weight on the affected joint.

1. Second degree sprains

A grade II or moderate sprain happens the tears going further and cause the following symptoms:

• Bruising
• Moderate pain
• Swelling
• Difficulty putting weight on the joint
• Some loss of function.

1. Third-degree (most severe) sprains

A grade III sprain is usually severe and happens in case of complete tear or rupture of a ligament. Usually, people are unable to put weight on the joint and have severe:

• Pain
• Swelling
• Bruising

Diagnosis of a sprain can be made through several steps.

People may suspect themselves of having sprains if they develop symptoms. Medical professionals could assist with the diagnosis through history taking, physical examination of the area of injury, and imaging tests such as X-ray, ultrasound, or MRI. 6 7

Ultrasound imaging is a non-invasive, safe, and painless medical test to help to diagnose and treat medical conditions. It produces an image of the inside of the body using sound waves. This method uses a small probe called a transducer and gel placed directly on the skin. The probe collects the sounds that bounce back after a high frequency of waves sent into the body through the gel.

Ultrasound exams do not involve radiation. Ultrasound can capture images in real-time and it can show the structure and movement of the internal organs. Ultrasound images of the musculoskeletal system can provide pictures of muscles, tendons, ligaments, joints, nerves, and soft tissues throughout the body.

Magnetic resonance imaging (MRI) is another noninvasive test used to diagnose medical conditions. MRI uses a powerful magnetic field, radiofrequency pulses, and a computer to produce detailed pictures of internal body structures. Detailed MR images allow doctors to examine the body and detect disease. This scan test is the choice for examining the:

• major joints,
• spine for back pain,
• soft tissue (muscles, tendons, and ligaments) of the extremities.

Important signs should be assessed when an injury happens to decide whether it can be treated at home or needs professional help. Be aware of any deformities, significant swelling, and changes in skin colour. If there are deformities, significant swelling, or pain, it is advised to immobilize the area and seek medical help immediately. 5

Initial treatment for sprains and strains follows the PRICE principle. PRICE principle is suggested for the first 24 to 48 hours after the injury.PRICE stands for: 5 8

• ProtectionProtect the area of concern from further injury by trying to immobilize the area or stay off a weight-bearing joint to prevent further motion and restore alignment. It also may be advisable to use a brace/splint or crutches to stay off the injured area.
• RestRestrict the activity and cut back on regular exercises and activities of daily living. An injury like a sprain requires a change in normal routine to let the area heal.
• IceApply an ice pack to the injured area. Do this for 10-15 minutes every two or three hours. A cold pack, ice bag, or plastic bag filled with ice wrapped in a towel can be used. Avoid the risk of ice burn by not touching the skin with ice directly or applying the cold pack for too long.
• CompressionCompression (continuous pressure) of the injured area may help reduce swelling. Use an elastic compression bandage to wrap the affected area. For the upper body, wrap the affected area always from fingers towards the shoulder, while for the lower body, do it from toes to the groin. A bandage should feel snug, but not so tight it is uncomfortable or cuts off the circulation. An easier way to apply compression from the knee down is with compression stockings.
• ElevationElevating the injured area may help to decrease swelling. Keep the injured area elevated on a pillow. Try to keep the injury above the level of your heart.

• Imaging tests to support the diagnosis of a severe sprain or strain or rule out a broken bone.
• More advanced immobilization of the limb or joint with a splint, cast, or other devices until healing is complete. Rehabilitation or physical therapy can often be helpful to bring an injured joint back to normal.
• In severe cases, surgery may be needed.

If the injury is mild and the affected person can tolerate the pain, it may not need any medication. If needed, some painkiller options can be obtained over the counter or prescribed by doctors. The options include the following: 8

• ParacetamolParacetamol is useful to ease the pain. It is best to take paracetamol regularly, for a few days or so, rather than now and then. The recommended dose for adults is one to two 500 mg tablets, four times a day, and always give at least four hours interval between doses. If the pain is more severe, a doctor may prescribe stronger painkillers.
• Anti-inflammatory painkillersThese medicines are also called non-steroidal anti-inflammatory drugs (NSAIDs). They relieve pain and may also limit inflammation and swelling. Ibuprofen and Naproxen are a few examples of anti-inflammatory medication that can be obtained at a pharmacy without a prescription. It is suggested to be cautious when taking any NSAIDs for any potential side effects.
• Topical anti-inflammatory painkillersSame as NSAIDs, some topical anti-inflammatory painkillers can be obtained without a prescription at pharmacies. These usually contain ibuprofen or diclofenac. Some others may have cooling ingredients, such as menthol, which can give a relieving effect when it is applied. The effectiveness of this option is not clear. However, there is less risk of side effects of using topical painkillers.

Severe grade of muscular or ligament injury may require surgical intervention to repair the tear. The main surgical indications include: 9

• a large intramuscular hematoma(s),
• a complete (III degree) strain or a partial (II degree) strain if more than half of the belly muscle is torn
• persistent pain for more than 4 months with functional impairment

Some cases of sprain can not be avoided. However, the following efforts may lower the risk of injury: 10

• Use protective gear during high-impact sport (for example, wearing protective footwear during activities that place stress on the ankle).
• Wearing proper fit shoes
• Avoid wearing high-heeled shoes
• Always warm-up and stretch before doing exercise and sports
• Avoid high impact sports and activities without any adequate training
• Maintain muscle strength and flexibility.

The outlook after an event of a sprain may depend on the severity of the injury. The length of recovery time also may vary. In mild sprains, recovery may be achieved in only a few weeks. In more severe sprains, it could take up to 12 weeks to recover. Surgical repairs of completely torn ligaments will have the longest recovery. 4

• Grade 1 (mild) usually heals with conservative treatment, with minimal long-term complications.
• Grade 2 (medium) has a high risk of tear extension in the first 4 to 6 weeks. Therefore rapid return to work is to be avoided.
• Grade 3 (severe) can be associated with significant complications. Grade 3 ligament tear also can lead to chronic pain, loss of function, and secondary degenerative changes in the joint regardless of the choice of treatment.

Some of the most common long term complications are:

• Muscle fibrosis,
• Muscle atrophy,
• Chronic ligament instability.