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Strains & Sprains

 


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Condition
Strains and sprains
Class
Musculo-skeletal system
Description
Strains and sprains are two separate conditions but are considered together because they often occur under similar circumstances and are treated in a similar way. A strain is when a muscle or tendon is either over-stretched or torn. A sprain happens when the ligaments of a joint are over-stretched or torn.
Causes
In order to understand the causes of strains and sprains, it is important to understand the relationship between muscles and joints that brings about movement.
A muscle is made from many individual fibres and is attached to a bone by means of a band of tough, inelastic fibrous tissue called a tendon. When the muscle contracts, the fibres in the muscle shorten which creates a pull on the tendon and so makes the bone move. As bones are stiff and rigid, they cannot bend and so can only move at the position of a joint. A ligament is a sheet or band of tough, fibrous tissue connecting bones or cartilages at a joint which determines the range of movement of the bone when the muscle contracts.

Strains affect muscles and tendons. Sudden twisting, a sharp pull or a direct impact can cause the fibres in the muscle and tendon to tear, causing a strain. Lifting heavy or awkward weights incorrectly is a common cause of back strain. Chronic strain can develop as the result of over-use of a muscle by repeating the same action time and time again. The muscle fibres and tendons become inflamed through over-use. This type of injury is called repetitive strain injury or RSI. Any muscle can be affected, but strains commonly occur in the neck, wrists, arms and shoulders.

Sprains happen because a joint is suddenly forced out of its normal position. This over-stretches or tears the supporting ligaments. For example, sprains often occur when a foot, ankle, knee or wrist becomes twisted during a stumble or fall.
Symptoms
The symptoms of a strain are typically a short, sharp sudden pain, muscle spasm and muscle weakness. Movement of the area affected can be very painful, but movement is still possible.

Pain, swelling, bruising and loss of function are the commonest symptoms of a sprain. If the sprain is severe, there may be total loss of movement of the joint affected. For example, a severe ankle sprain may prevent walking. Sometimes, the person may be aware of a pop if the ligament tears.

The time needed for full recovery after a sprain or strain depends on the severity of the injury. A moderate ankle sprain may require 3 to 6 weeks before full recovery, while a severe sprain with tearing of the ligament may take 8 to 12 months before the ligament is fully healed.
Treatment
Most mild strains and sprains respond to what is known as RICE therapy. These initials stand for rest, ice, compression and elevation. Swelling and pain can be reduced if, as soon as possible after the injury, the following steps are taken:

  • Rest - stop the activity that caused the injury and rest the affected muscle or joint for about 48 hours.
  • Ice - for about 20 minutes apply something cold to the affected area such as crushed ice in a polythene bag wrapped up in a towel. If ice is not readily available, a bag of frozen peas works very well as it can be shaped to surround the injured area. Again, wrap the bag of peas in a towel to avoid freezer burns to the skin.
  • Compression - bandage the area securely to reduce swelling and to reduce movement. Do not apply the bandage too tightly or it will restrict circulation.
  • Elevation - raise the injured area to reduce swelling. If the strain or sprain is in the legs, sit or lie down with the injured area raised on a cushion. If the injured area is in the arm, try to raise the arm above chest height.
Once the pain and swelling begin to go, start some gentle exercises to stop the joint from stiffening and to help build up the strength of the muscles.

There are many products that can help reduce pain and inflammation during the healing process. Sprays, rubs, liniments, rubefacients and gels containing cooling agents; products to ease pain and inflammation such aspirin derivatives, ibuprofen, ketoprofen and piroxicam; plasters containing belladonna to relieve spasm can all be applied to the affected area to relieve pain. These topical preparations are also useful to ease muscle stiffness that may occur when someone is not used to exercising. The act of rubbing any of these topical preparations into the affected area also helps ease discomfort. Bruising may be reduced by the use of ointments containing arnica tincture.

If the person suffering from a sprain or strain is unable to apply these preparations, or prefers not to use them, pain killers in the form of tablets or capsules containing paracetamol, aspirin or ibuprofen can be taken orally.

Stronger analgesics such as codeine or dihydrocodeine can be used for acute, moderate pain which is not relieved by paracetamol, ibuprofen or aspirin alone, but it is important that codeine or dihydrocodeine are used only for short term treatment and taken for no more than 3 days as they may cause addiction.

Moderate sprains may require a splint or plaster cast to rest the joint. More serious injuries involving tears to the ligaments may require surgery followed by physiotherapy.
When to see your pharmacist
Your pharmacist is able to supply a wide range of oral analgesics, topical analgesics and rubefacients without the need for a prescription. Always tell your pharmacist if you are taking any other medicines or have any other medical conditions. Some of the preparations, for example those that contain aspirin or derivatives of aspirin, or drugs known as non-steroidal anti-inflammatory drugs, should not be taken by people who have developed asthma or other allergic reactions to these drugs in the past. These preparations should also be avoided by women who may be pregnant or breast feeding. These drugs may also interfere with the action of other medicines such as warfarin, increasing the risk of bleeding.

Your pharmacist is also able to supply a range of dressings and bandages that can be used to support joints during exercise or to provide compression as part of RICE therapy.
When to see your doctor
You should seek medical help if you have any of the following problems following your injury. If the injury is very painful, if you cannot bear any weight on the joint, if you cannot walk more than a few steps without severe pain, if the limb buckles or cannot move when you try to use it.

You should also see your doctor if the area over the joint is very tender to touch, if it looks crooked or has unusual lumps. Redness or red streaks spreading out from the injury should also be investigated.

Always seek medical advice if you are in doubt about the seriousness of the injury or how to care for it. Your doctor may request an X-ray of the area to check for possible fracture, or may refer you to a specialist if there is a serious tear that needs surgical repair. You may also require physiotherapy after an injury to restore joint mobility and strengthen weakened muscles.
Living with strains and sprains
Prevention
Strains and sprains commonly occur as a result of sports injuries. The risk of getting strains and sprains can be greatly reduced if a few simple precautions are taken. Always 'warm up' with some simple stretching exercises before taking part in any sport. Similarly, always 'warm down', finishing the exercise session with gradually less vigorous activities. To keep muscles and joints in good working order, exercise regularly and within your own personal limits.

To prevent strains and strains occurring in other circumstances, wear appropriate footwear and take extra care if walking on uneven surfaces, learn to lift weights correctly, take regular breaks if repeating the same activity.

If you have a previous history of strains or sprains, use compression bandaging or supports on areas such as knees, ankles, elbows and wrists. Try to avoid situations or take extra care when you know to be at risk.

Management
If you do suffer from a sprain or strain, follow the RICE guidance described above. Gradually build up your level of activity of the injured area as soon as the acute pain and swelling has eased to prevent stiffness and restore normal range of motion of the muscle or joint.
Useful Tips
  • Watch your weight to avoid undue pressure on the back and limbs
  • Lift heavy loads correctly or get help with them to avoid back strain
  • Remember safety measures to prevent falls - keep stairways and work areas free of clutter
  • Wear proper footwear when walking, exercising or playing sport
  • Warm up and stretch before participating in sports or gym work and, just as importantly, warm down and stretch again when finished
  • Do not take analgesics regularly or for long periods


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