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Sprains and strains
Sprains and strains are usually minor injuries that often result from sports, exercise, or other physical activity. Sprains refer to an injury to a ligament (the connective tissue that links bones together at joints), most often in the ankle, knee, elbow, or wrist. Strains are tears in muscle tissue, commonly occurring in the muscles that support the calf, thigh, groin, and shoulder. Sometimes sprains and strains can be severe, leading to weeks of rehabilitation.
Signs and Symptoms
Strains:
• Muscle stiffness, tenderness, or soreness
• Swelling
Sprains:
• Pain at the time of injury
• Swelling
• Bruising
You may have joint instability or disability if the injury is serious, involving a muscle or ligament tear.
What Causes It?
Sprains generally result from a twisting force applied to a joint while it is bearing weight, causing the ligament to stretch beyond its natural limit. Sprains usually occur with sudden, unexpected
movement (a fall or a twist). Muscle strains occur when the weight load on a muscle is greater than the weakest part of the muscle can bear. Strains usually happen during activities that require
your muscle to stretch and bear weight at the same time. Some evidence suggests that previous injuries or limited flexibility contributes to sprains. You are at risk for a sprain or strain if
you do the following:
• Exercise without warming up properly
• Use athletic equipment that does not fit properly
• Participate in sports and activities that you are not conditioned for
• Exercise when bones and muscles are fatigued
What to Expect at Your Provider's Office
Your health care provider may take an x-ray. If your injury is severe, your health provider may order other imaging tests, such as magnetic resonance imaging (MRI). Your injured limb may need to
be wrapped in an elastic bandage or put in a soft cast.
Treatment Options
Your health care provider may recommend that you treat the injury with RICE: rest, ice (wrapped in a cloth or a towel -- do not apply ice directly to the skin), compression, and elevation of the
affected area. Apply RICE as needed over the first several days following the injury.
Ice reduces pain, bleeding, and inflammation. It may also reduce secondary damage to other parts of the joint. Some evidence suggests that applying ice and using nonsteroidal anti-inflammatory
drugs improves healing and speeds recovery. Bleeding and inflammation may play an important role in the healing process. For more severe cases, wrap the affected area in an elastic bandage. A cast
may be required to stabilize injuries.
You should limit activity that involves the affected area for an average of 7 days. You may also be referred to a physical therapist, who will tailor exercises to help you strengthen muscles, joints,
and ligaments.
Drug Therapies
Over-the-counter pain relievers (analgesics) and anti-inflammatory agents usually help. However, you should talk to your doctor for adequate dosing. When injuries are more severe or chronic, continued
use of analgesics may lead to aggravation of the condition. Analgesics should not be used to mask pain so that you can resume activity without immobilizing the injured area.
• Aspirin -- 325 mg, 1 - 2 tablets every 4 hours
• Naproxen -- 210 mg, 2 - 3 tablets every 8 - 12 hours
• Ibuprofen -- 200 mg, 2 - 3 tablets every 4 - 6 hours
• Analgesic balms
• Acetaminophen -- 325 mg, 1 - 2 tablets every 4 hours
Complementary and Alternative Therapies
Specific nutrients and herbs may help the body restore damaged tissue, reduce swelling, and provide pain relief.
Nutrition and Supplements
• Vitamin C (250 - 500 mg two times a day) and beta-carotene (50,000 IU per day for 5 days) both help the body produce connective tissue and may reduce pain.
• Bromelain (250 - 500 mg three times a day between meals), an enzyme derived from pineapple, has anti-inflammatory effects and helps reduce swelling.
• Zinc (15 - 30 mg per day) helps wounds heal faster.
• Vitamin E (400 IU/day) has antioxidant effects.
• Glucosamine and chondroitin, popular supplements for arthritis, may also help wounds heal faster, though studies are lacking. Usual doses are: glucosamine, 1,500 per day; chondroitin, 800 - 1,200
mg per day, divided in two to four doses. They are often combined in one supplement.
Herbs
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your provider to diagnose your problem before starting treatment. You may use
herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water.
Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.
• Turmeric (Curcuma longa) helps reduce swelling and makes the effect of bromelain stronger. Take 250 - 500 mg each of turmeric and bromelain, three times a day between meals.
• Applied topically, the active ingredient in horse chestnut (Aesculus hippocastanum), called aescin, may reduce tenderness and swelling. Apply a gel with 2% aescin to the affected area every 2
- 3 hours.
• Applied topically, a gel containing comfrey (Symphytum officinale) may also help reduce pain and swelling. You should use comfrey only topically. Do NOT take internally.
• White willow (Salix alba) acts similar to aspirin and can reduce inflammation and swelling. Make a tea by boiling 1/2 teaspoon (2 grams) of bark in 8 ounces of water. Drink up to 5 cups per day.
If you are allergic to aspirin or salicylates, check with your doctor before using white willow.
Homeopathy
Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for sprains and strains based
on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced
homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
• Arnica (topical) -- this remedy is generally considered the first-choice homeopathic treatment for acute injury. It is applied topically in addition to an appropriate internal remedy. You should
not use arnica, however, if the skin has open cuts over the injured area.
• Arnica (internal) -- for injuries with swelling, bruising, and inflammation. You should switch to another appropriate remedy once swelling has subsided.
• Bryonia -- for swollen injuries that get worse with movement. This remedy is especially useful for chest, shoulder, and hamstring injuries. It is often used if Arnica or Rhus toxicodendron fails.
• Ledum -- for sprained ankles that feel cold or numb but improve with cold applications (such as ice) and worsen with warm applications.
• Rhus toxicodendron -- this remedy is used after the initial symptoms of an injury have improved (such as from using Arnica). For pain during initial movement that subsides with more movement.
The affected area generally feels hot. This remedy is especially appropriate for lifting or overexertion injuries.
• Ruta -- for tendonitis, torn ligaments, and other injuries that feel hot to the touch. Ruta is very useful as a treatment for overexertion injuries, such as tennis elbow and runner's knee. Symptoms
tend to be worse with initial movement, but continued motion does not bring relief.
• Traumeel -- for management of mild to moderate injuries. One study found that Traumeel was as effective as conventional medicines for reducing the pain and inflammation associated with injuries,
such as sprains, strains, and contusions.
Acupuncture
Acupuncture appears to be effective for sprains and strains. One study of 20 people found that acupuncture improved feelings of soreness. Acupuncturists often apply moxibustion (a technique in
which the herb mugwort is burned over specific acupuncture points) in combination with needling in order to strengthen or deepen the treatment for this condition.
Chiropractic
A significant number of people who visit chiropractors do so for sprain and strain injuries. In addition to joint manipulation, chiropractors use other treatments for sprains and strains, such
as applications of ice and heat and ultrasound or electrical muscle stimulation. Chiropractors may also recommend stretching and strengthening exercises to aid recovery and rehabilitation. One
study found that a balance training program significantly reduced the risk of ankle sprains among high school soccer and basketball players.
In a study of people with ankle sprains, researchers compared the effectiveness of chiropractic joint manipulation with an anti-inflammatory medication. They found that joint manipulation was as
effective as the anti-inflammatory medication in improving pain and flexibility, but it was more effective than the medication in improving range of motion.
Massage
Therapeutic massage is effective at increasing circulation and may relieve spasm in surrounding muscle groups.
Following Up
Your health care provider probably won't need to see you again unless your injury was severe or you have complications.
Special Considerations
Be careful of recurring sprains and strains. Once a muscle or tendon is injured, it is susceptible to injury again, especially if you return to full activity too soon. Sprains and strains are easy
to prevent. Basic physical fitness and strength training with proper warm-up and cool-down reduce the stress to muscles and joints.
Reviewed By: Harvey Simon, MD, Editor-in-Chief, In-Depth Reports; Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.
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