Strains / Sprains

Strains / Sprains

People are able to move because muscles contract and make the joints that they cross, move. Muscles attach on each side of the joint to bone by thick bands of fibrous tissue called tendons. When a muscle contracts, it shortens and pulls on the tendon, which allows the joint to go through a range of motion.

A strain occurs when the muscle tendon unit is stretched or torn. The most common reason for this is the overuse and stretching of the muscle. The damage may occur in 3 areas.

The muscle itself may tear.
The area where the muscle and tendon blend can tear.
The tendon may rip away from the bone.

Joints are stabilized because thick bands of tissue called ligaments surround them. These ligaments only allow the joint to move in specific directions. Some joints move in multiple planes; therefore, they need more than one group of ligaments to hold each joint in the proper position. The ligaments are anchored to bone on each side of the joint. If a ligament is stretched or torn, the injury is called a sprain.

Sprains and Strains Causes

Sprains and strains occur when the body is put under stress. In these situations, muscles and joints are forced to perform movements for which they are not prepared or designed to perform. An injury can occur from a single stressful incident, or it may gradually come on after many repetitions of a motion.

Sprains and Strains Symptoms

The first symptom of a sprain or strain injury is pain. Other symptoms, such as swelling and spasm, can take time (from minutes to hours) to develop.

Pain is always a symptom that indicates that there is something wrong with the body. It is the message to the brain that warns that a muscle or joint should be protected from further harm. In work, exercise, or sport, the pain may come on after a specific incident, or it may gradually progress after many repetitions of a motion.

Swelling almost always occurs with injury, but it may take from minutes to hours to be noticed. Any time fibers of a ligament, muscle, or tendon are damaged, some bleeding occurs. The bleeding (such as bruising on the surface of the skin) may take time to be noticed.

Because of the pain and swelling, the body starts to favor the injured part. This may cause the muscles that surround the injured area to go into spasm. Hard knots of muscle might be felt near the site of the injury.

The combination of pain, swelling, and spasm causes the body to further protect the injured part, which results in difficulty with use. Limping is a good example of the body trying to protect an injured leg.

When to Seek Medical Care

Sometimes you need to see a doctor for help in diagnosis and treatment. For strains or sprains, the pain can increase in the first 1-2 days, as the spasm surrounding the injury sets in. If after trying RICE (see Self-Care at Home) and over-the-counter medications, the pain is not controlled or if the injury may be more severe than initially believed, then a visit to a doctor is wise. A doctor's visit also is important if swelling gradually develops over a large joint, such as a hip, knee, elbow, or wrist.

Sometimes you need the help of hospital equipment and specialists. Seek care immediately in any of the following cases:

If you are concerned that a bone is broken or a joint is dislocated
If you have numbness or tingling associated with the injury (This may signify damage to a nerve.)
If the injured part of the body is cold and discolored (This may be associated with damaged blood vessels and loss of circulation.)
Children present a special situation. Due to growing bones, muscles, and tendons, these structures can react differently to stress. Parents can be rightly concerned about possible broken bones. Remember, even if you can walk on an injured limb or move it, you may still have a broken bone. It just means that the muscles and tendons are working across the joint.

Exams and Tests
When visiting the doctor, expect many questions about the accident. The mechanism of injury can give clues as to what stresses were put on the body part and what injuries likely happened. The doctor will perform a thorough physical examination of the injured area. The physician will want to examine the joint above and the joint below an injury to make sure no hidden injuries are missed.

The doctor may need to take x-rays or perform other tests. X-rays only show bones and not the soft tissues, such as the muscles, tendons, and ligaments. The physician determines when it is appropriate to order x-rays and when certain injuries, especially of knees, ankles, and the low back, are very unlikely to warrant x-rays to rule out any broken bones. The physician should discuss the reasons for or against taking x-rays.
Sprains and Strains Treatment Self-Care at Home

Initial treatment for sprains and strains should occur as soon as possible. Remember RICE!

Rest the injured part. Pain is the body’s signal to not move an injury.
Ice the injury. This will limit the swelling and help with the spasm.
Compress the injured area. This again, limits the swelling. Be careful not to apply a wrap so tightly that it might act as a tourniquet and cut off the blood supply.
Elevate the injured part. This lets gravity help reduce the swelling by allowing fluid and blood to drain downhill to the heart.

Over-the-counter pain medication is an option. Acetaminophen (Tylenol) is helpful for pain, but ibuprofen (Motrin, Advil, Nuprin) might be better because these medications relieve both pain and inflammation. Remember to follow the guidelines on the bottle for appropriate amounts of medicine, especially for children and teens.

Medical Treatment

Sprains and strains can usually be treated without surgery. The home treatment with RICE is sufficient. Some injuries, however, need operations to fix complete tears of muscles or tendons that do not allow them to do their job of moving the body. Significant tears of ligaments that stabilize joints also may need repair.

Sometimes, resting the injury requires some help. Slings for arm injuries or crutches for leg injuries can be used, in addition to a variety of removable splints to protect the injured area from further damage and movement. Resting also helps relieve some of the muscle spasm associated with the injury.
Occasionally, if the injury is especially severe, the physician may want to use a non removable splint made of plaster or fiberglass. Although the splint may look like a cast, it doesn't have plaster or fiberglass completely encircling the injured area. Instead, by only going partially around an injury, there is some room to allow for swelling that may occur during the next few days.

If the need for an operation is considered, an orthopedic (or bone) specialist is likely to become involved. Many times these decisions are made over a period of a few days and not immediately, unless there is concern about the stability of a joint or damage to an artery or nerve.
Next Steps Prevention

Sprains and strains are caused by accidents. People don’t plan on becoming injured, but there are some suggestions that may help prevent injuries. Muscles need to be warmed up before exercise and work. A stretching program is helpful in minimizing the risk of injury. Even simple tasks at work can cause painful strains if the body is not ready to do the work.

The goal of treatment for sprains and strains is the return to the level of function that the person had before the injury. This means that the expectation is for the injury to completely heal. The time frame for recovery depends on the severity of the injury. It may take just a few days for a slight sprain of an ankle to heal, or it may take months for a knee that has to be surgically reconstructed.

Perhaps the most important therapy for all injuries is rehabilitation. This may be a home exercise program that your doctor outlines, or it may be a formal physical therapy program. You should have an understanding before leaving the office or hospital of what work is expected to rehabilitate the injury. Ask the following questions:

What limitations are there for activity and work?
What is the time frame for recovery?
When is it safe to return to full activity?
When should a reevaluation be scheduled?

PT Hawaii Reference from WebMD Medical Reference and eMedicineHealth (June 24, 2009)

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