Sprains & Strains

Written by Keith Allen Shirtcliffe

Sprains and strains happen when soft tissues are stressed or stretched beyond their limits. We usually refer to ligament injuries as sprains when they are stretched beyond their length. The injury force is too great for the ligament to hold and it tears. The term strain is usually used for muscle and tendon tears.

A grading system of 1-3 is used to describe the tear:

  1. A minor injury which will give some swelling but the sports person will usually be back in action in a matter of days, providing they treat it correctly (see below).
  2. A more significant partial tear which will give quite a lot of swelling and take several weeks to repair, depending on how torn the structure is. You should always see a qualified Physiotherapist to have this assessed and treated. It is important to limit scar tissue and ensure a full recovery of strength, joint movement and control before sport is resumed.
  3. A complete tear, or rupture. This may actually be less painful than a grade 2 as the injured structure is no longer being stressed but it is a more serious injury that will often require a plaster cast or surgery, or both.

What to do?

If you suffer a sprain or strain it is important to do the right things. We recommend following the PRICE principles below. These are based on our experience in sports physiotherapy and the research carried out by the Association of Chartered Physiotherapists in Sports Medicine (ACPSM).

P = PROTECTION

Basically this involves avoiding the risk of further injury. This means not trying to continue a game or run when you feel a ‘pull’. It can mean using a brace or strapping, or reducing weight bearing with crutches.

R = REST

Again referring to unloading the injured structure. E.g. try not to spend hours on your feet the day after a sprained ankle, even if it is strapped or bandaged. Don’t be too ambitious about getting back to activities too quickly. Accept that things take time to repair properly.

I = ICE

The ACPSM recommend crushed ice be applied for at least 10 minutes to reduce pain after an injury. This may also help avoid excessive swelling from causing further tissue damage. It is not recommended to keep the ice on for more than 20-30 minutes but it can be reapplied every 2 hours, or sooner if more pain relief is required. Protect from skin burns with a damp tea towel as abarrier.

C = COMPRESSION

A simple crepe bandage can help to limit swelling in the early stages. This should be snug but not restricting blood flow. Physiotherapist will sometimes add more focal compression under a bandage to improve the effect, e.g. around the outer ankle bone. Later on, strapping can give the athlete confidence and help them return to their sport earlier.

E = ELEVATION

This is particularly useful to reduce pain and swelling for injuries of the knee or below. If you lie on the floor or bed with your foot up high on the wall the swollen area will be higher than your heart and the fluid will drain more effectively. Gentle movement of knee and ankle whilst elevated will make this even more effective.

REMEMBER: IF IN DOUBT – GET IT CHECKED OUT!

Please see our sections on rehabilitation and sports rehabilitation.