Sometimes the terms sprain and strain are used interchangeably by patients, but a sprain usually occurs with a ligament and a strain with a muscle or tendon,” says Killarney and Macroom-based chartered physiotherapist, Ruth Allen.
“The ligaments are tissues that connect bone to bone so your sprain usually only occurs around the joint,” she says. “The most prominent areas for sprains are ankles, knees and wrists or maybe toes or fingers for contact sports.”
Strains are different. They relate to a muscle or tendon being overstretched or torn.
“A strain is associated with a contractile element where a muscle or tendon moves a joint through a range of motion. Muscle and tendons attach to the bone so it’s tissue to the bone in this case.
Tendons attach the muscle to the bone. A strain occurs when a tendon or muscle is overstretched.”
Strains can sometimes involve fibres from the muscle into the tendon, however.
“They may not be completely in the muscle belly, they might just cover the muscle and tendon area,” she says.
Summer can be a time when more sprains and strains are experienced.
“Emergency departments would say that they have higher incidence of sprains and strains in the summer. It’s common sense really, the general population is out participating in sport, summer camps, GAA, activities, outdoor pursuits and runs…
People are walking fields in summer too where it’s easy to walk into a hole.
“On the other hand, when it comes to the sporting population, you’d see more sprains and strains in the autumn/winter period when the pitches get muddy and may be more uneven.”
The symptoms of sprains and strains are often the same, she says. They include pain on walking or movement.
“It depends, of course, on the severity. For the most part in sprains or strains that last more than five days you will have pain on weight bearing or walking or movement if it is the upper limb.
Swelling or bruising is very common too and there will be an inability to put it through a full range of movement, pain free.”
But would a person know if they had a sprain or a strain?
“It depends where it is,” she says. “If it is your ankle, 99% of time it’s a sprain.
Usually we tell a lot from how the person has injured themselves – the mechanism of injury.
If you are out running across a field after a cow and you feel a sudden sharp pain in the back of your leg or in the front of your thigh that’s usually a strain - a muscle injury - whereas if you were running across the field and you tripped or fell on an outstretched hand and hurt your wrist, that is more than likely a sprain around the joint.
The ligament is probably the issue there or it might even be a bone issue. You’d usually see more bony issues associated with sprains than you would strains.”
When to have an x-ray
So when exactly does a person need to have an x-ray when they hurt themselves?
“An x-ray is needed if there is a lot of pain on palpation [pressing on the surface of the area].
Usually an injury feels better after a few days, you’re able to take more weight on it and then walk pain free – that’s the progression.
If it continues to be sore and swollen and bruised and swells up more after you put some weight on it after a few days that’s usually an indication that there might be a bone injury there.”
There would be very sharp pain if there is bone injury involved.
“When I palpate it, the pain will lift somebody off the physio plinth.”
Seeking attention if the sprain or strain doesn’t improve after a few days is advised.
“A physiotherapist will diagnose a bad sprain or strain or a possible bone injury.”
Sometimes getting x-rays done too quickly is not a good idea, she adds.
“That’s because the bone injury may not be picked up because of the swelling in the area.
You’re probably better off going to a physiotherapist first who will be able to advise about whether or not an x-ray is needed.”
She points out also that we can’t always prevent strains and sprains. That’s because external factors may vary.
“Ground surface may be poor, for example, or we may have had to do something really fast e.g. dodge a cow.”
We can manage intrinsic factors ourselves, however.
“Strength conditioning is one thing we can do to keep the body fit and healthy and as strong as possible.
That doesn’t mean going to the gym every day, but yoga and Pilates are very good. Balance work for the upper and lower body is good too - tai chi and again yoga and Pilates.
Physiotherapists are big advocates of those as they are holistic type exercises, helping body and mind. Sleep hygiene and proper nutrition are important too in avoiding injury.”
Initial treatment for both sprains and strains can be really easy, she says.
The old easy-to-remember mnemonic advice of RICE, (rest, ice, compression, elevation) or later, PRICE (protection, rest, ice, compression and elevation) has now been updated to PEACE AND LOVE, she states.
You don’t want anything further to happen to it, so if there is a graze or cut cover it.
This is key – put it up to stop too much blood profusion to the area and decrease inflammatory fluid lodging in the area.
Avoiding anti-inflammatories for the first 24 hours is usually a good idea. You don’t want the tissue healing process to be delayed.
This is very important for reducing inflammation and swelling.
The patient on what to do and not do.
Optimal load is a very important issue with injuries, for stimulating healing. This can vary from person to person.
You want to be able to stress the injury in a relatively pain-free way e.g on a pain scale 0-10, loading it to 1-2.
How much to do is very individual. Your physio will advise you.
We would encourage people to move the injured limb quite soon, for example, doing ankle circles or making the shapes of the alphabet with your foot for an ankle sprain.
This helps to minimise swelling and the joint then isn’t going to be as stiff. Moving it is going to get blood flow into it also to aid healing.
Don’t listen to negative stories. Positivity will help you recover.
Move and do pain free cardiovascular activity to increase blood flow to all the areas and, most importantly, to the injured area.
Cycling, working in the pool, perhaps use a cross trainer or elliptical trainer or rowing machine as appropriate to increase blood flow.
Adopt an active approach to your recovery. Get mobile and back into your strengthening and balance work. This is linked to optimal load. Don’t do nothing because that’s not good for healing.
Lots of different sports needed
Children should be encouraged to do lots of different kinds of sports from a young age, she says. This is to develop what’s called their very important proprioceptive mechanisms.
“There were very little options years ago, but now the experts say that the more sports kids can do the better as they grow up into adolescence.
This is preferable to specialising in one or two. It goes back to the past when children used to climb trees and run through meadows and were very active.
“They need to be doing a wide array of sports where kids are jumping and landing, doing hand stands and putting their joint ranges through lots of different movements so they are working their balance straight away and their proprioceptive mechanisms are being engaged from a young age.
“If I have to run on a sports field and change direction really quickly, my proprioceptive mechanisms have been trained from a young age to allow my joint to move outside of that normal range of motion so I’m not going to lose my balance.
It comes back to children developing good movement techniques and good movement quality from a young age because it is very hard to retrain bad movement habits or sub optimal bio mechanics when children are older.
If good habits are developed from an early age, you are less likely to have those injuries later in life.”
Broken a bone? Change in treatment advice
Twisted your ankle and chipped/broken a bone? In the past, the foot would have been put in a cast, but this isn’t the case for minor injuries now.
“We don’t see many injuries cast anymore,” Ruth Allen says.
“Minor bone injuries tend to be splinted or put in medical boots unless they are very bad.
It is believed now that healing takes longer if you are putting no load through the area at all.
We do need a certain amount of load put on an area to stimulate healing.”