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Sprains and strains Content Supplied by NHS Choices
Introduction

Sprains and strains are very common injuries that affect muscles and ligaments.

They often occur when playing sports if you change direction or speed suddenly, fall and land awkwardly, or collide with an object or person.

Read more about the causes of sprains and strains.

Sprains

A sprain occurs when one or more ligaments have been stretched, twisted or torn, usually as a result of excessive force being applied to a joint. Ligaments are strong bands of tissue around joints that connect bones to one another.

Common locations for sprains include the knees, ankles, wrists and thumbs. Symptoms of a sprain can include:

  • pain around the affected joint
  • inability to use the joint normally or put weight on it
  • swelling, bruising and tenderness

There may be swelling soon after the injury but the bruising may not show until later or it may not show at all.

Bruising sometimes develops away from the affected joint, as blood seeps along the muscles before surfacing to the skin.

Strains

A strain occurs when muscle fibres stretch or tear. It's usually the result of the muscle being stretched beyond its limits or forced to contract (shorten) too quickly.

Muscle strains are particularly common in the legs and back, such as hamstring strains and lumbar (lower back) strains.

Symptoms of a muscle strain can include:

  • swelling, bruising or redness
  • pain in the affected muscle at rest
  • pain in the muscle or associated joint during use
  • muscle spasms (when the muscles contract tightly and painfully)
  • weakness and loss of some, or all, of the function in the affected muscle

When to seek medical help

Most sprains and strains are relatively minor and can be treated at home (see below).

However, you should visit a minor injuries unit (MIU) or your GP if you think you have a sprain or strain and:

  • the pain is particularly severe
  • you can't move the injured joint or muscle
  • you can't put any weight on the injured limb or it gives way when you try to use it
  • the injured area looks crooked or has unusual lumps or bumps (other than swelling)
  • you have numbness, discolouration or coldness in any part of the injured area
  • the symptoms haven't started to improve within a few days of self-treatment

If you have any of these symptoms your injury will need to be assessed by a doctor. You might have a severe sprain or strain or another serious injury, such as a fracture.

Read more about diagnosing sprains and strains.

How sprains and strains are treated

Minor sprains and strains can usually be treated with self care techniques, such as PRICE therapy (protection, rest, ice, compression and elevation).

Generally, you should try to start moving a sprained joint as soon as it's not too painful to do so, whereas a strained muscle should normally be immobilised for at least a few days.

Ordinary painkillers, such as paracetamol, can be used to help ease any pain, although stronger medication can be prescribed if the pain is more severe.

Most people will regain full use of the affected body part within six to eight weeks, although severe injuries may take longer to heal and some people may experience persistent problems lasting several months or longer.

Read more about treating sprains and strains.

Preventing sprains and strains

To help prevent sprains and strains you should:

Read more about preventing sprains and strains.


Causes of sprains and strains

Sprains and strains often occur during sporting activities or accidents that involve a fall or collision.

You're at risk of getting a sprain or strain if you:

  • overreach
  • change direction or speed suddenly
  • fall and land awkwardly
  • collide with an object or person

You can sprain your ankle if you accidentally put your weight on the outside of your foot. If your whole body weight presses down on the outer ligament of your ankle, it can stretch or tear. Ankle sprains sometimes occur when walking or running over rough or uneven ground.

Sport

Sprains and strains often occur when playing sports as a result of physical contact and the sudden acceleration and deceleration involved.

Sports injuries are more likely to happen when a person starts a sport for the first time and their muscles aren't used to the physical stresses involved.

Experienced athletes can also get injured when they're at the peak of their training because the increased demands on their muscles can suddenly cause them to become strained.

Competitive athletes, such as sprinters, long-distance runners, gymnasts and footballers have a high risk of recurring muscle strains because of the intense nature of their training and the overuse of specific muscle groups.

Children are also at risk of injury while playing sports because they're still developing physically. However, despite the risk of injury, it's important to remember that physical activities have many important health benefits and can help increase a child's confidence and self-esteem.

Increased risk

There are a number of things that increase your risk of getting injured while playing sport or taking part in other physical activities. These include:

  • poor conditioning - a lack of regular exercise can weaken your muscles and joints, making them less flexible, which can mean they're more likely to become injured
  • poor technique - the way you distribute your weight when walking or running, or the way you land after jumping can increase your risk of injuring your knee or ankle
  • inadequate warm up - warming up before exercise helps loosen your muscles and increases your range of joint movement, thereby lowering your risk of sustaining a ligament injury; not warming up properly before exercising increases your risk of injury
  • fatigue - when your muscles are tired they're less likely to provide adequate support for your joints, and when you're tired you may find it more difficult to control your body's movements accurately

Read more about preventing sprains and strains.


Diagnosing sprains and strains

When diagnosing a sprain or strain, your doctor will ask how you injured yourself and examine the affected area. An X-ray may be needed in severe cases.

Your doctor will want to know about treatments you've already tried, as well as any medication you're currently taking that could affect the injury, such as anticoagulants (medication that reduces the blood's clotting ability).

The affected joint or muscle will be examined to assess the severity of your injury. Your doctor will check for:

  • pain, discomfort and tenderness in the injured area
  • swelling and inflammation
  • any lumps and bumps not usually present
  • bruising or bleeding in the joint or muscle

They'll also assess how much you can move the injured joint or muscle and whether you're able to put your weight on it.

If you have a severe sprain, your doctor may check whether the ligaments are loose. This is sometimes called joint instability, mechanical instability or ligamentous laxity.

X-rays

You won't usually need to have an X-ray if you have a sprain or strain unless:

  • you're unable to put any weight on your ankle, foot or leg
  • the bone is tender at specific points on your ankle, foot or leg
  • you have difficulty moving your knee

An X-ray may also be recommended if you're over 55 years of age and have injured your knee as you're at increased risk of bone fracture after this type of injury.


Treating sprains and strains

Most sprains and strains can be managed at home using over-the-counter painkillers to ease any pain.

If the injury is minor, you can look after yourself by using "PRICE therapy" and "avoiding HARM". These are described below.

PRICE therapy

PRICE stands for:

  • Protection - protect the affected area from further injury by using a support or, in the case of an ankle injury, wearing shoes that enclose and support your feet, such as lace-ups.
  • Rest - stop the activity that caused the injury and rest the affected joint or muscle. Avoid activity for the first 48 to 72 hours after injuring yourself. Your GP may recommend you use crutches.
  • Ice - for the first 48 to 72 hours after the injury; apply ice wrapped in a damp towel to the injured area for 15 to 20 minutes every two to three hours during the day. Don't leave the ice on while you're asleep, and don't allow the ice to touch your skin directly because it could cause a cold burn.
  • Compression - compress or bandage the injured area to limit any swelling and movement that could damage it further. You can use a simple elastic bandage or an elasticated tubular bandage available from a pharmacy. It should be wrapped snuggly around the affected area, but not so tightly that it restricts blood flow. Remove the bandage before you go to sleep.
  • Elevation - keep the injured area raised and supported on a pillow to help reduce swelling. If your leg is injured, avoid long periods of time where your leg isn't raised.

Avoiding HARM

For the first 72 hours after a sprain or muscle strain, you should avoid HARM. This means you should avoid:

  • Heat - such as hot baths, saunas or heat packs.
  • Alcohol - drinking alcohol will increase bleeding and swelling, and slow healing.
  • Running - or any other form of exercise that could cause more damage.
  • Massage - which may increase bleeding and swelling.

Moving sprained joints

Most healthcare professionals recommend you don't stop using a sprained joint. The injury will heal quicker if you begin to move the joint as soon as you're able to do so without experiencing significant pain.

Your doctor may be able to teach you a number of exercises that will help you improve the joint's functionality.

If you have a severe ankle sprain, you may be advised not to use it for a while, or even have it put into a cast for a week or so.

Immobilising strained muscles

Depending on your injury, the advice for muscle strains can vary. You may be advised to keep your injured muscle still for the first few days. Your doctor may recommend using a brace, cast or splint to help keep it as still as possible.

The aim of immobilising the muscle is to allow it to start healing, so you can move it without tearing or pulling it again in the same place. After a few days, you'll probably be advised to start using the muscle again.

Treating pain

Paracetamol is usually recommended for painful sprains or strains. If it doesn't help, you may need an additional stronger painkiller - such as codeine - that's only available on prescription.

Your GP may also prescribe a non-steroidal anti-inflammatory drug (NSAID) cream or gel, such as ibuprofen or ketoprofen, to help treat pain. Gently apply the cream or gel to the injured area and wash your hands immediately afterwards.

Ketoprofen can make your skin sensitive to light (photophobia). You should avoid exposing treated areas of skin to direct sunlight or artificial sources of light, such as sunlamps or sun beds, during treatment and for two weeks afterwards.

Oral NSAIDs, such as ibuprofen tablets, can also help reduce swelling and inflammation. However, they shouldn't be used in the first 48 hours after the injury because they may delay healing.

Physiotherapy

For more severe injuries, particularly muscle strains, your doctor may consider referring you for physiotherapy.

Physiotherapy aims to restore movement and function to an injured area of the body. The physiotherapist may show you exercises to help improve the range of motion and return normal function to the injured area.

This may reduce your risk of experiencing long-term problems or injuring the area again.

Recovery

The length of time it takes to recover from a sprain or strain depends on how severe it is.

Generally, after an ankle sprain you'll probably be able to walk a week or two after the injury. You may be able to use your ankle fully after six to eight weeks, and you'll probably be able to return to sporting activities after eight to 12 weeks.

For muscle strains, the time it can take to recover can vary considerably. Some people recover within a few weeks, whereas others may not be able to return to their normal activities for several months.

Some people may experience continued problems, such as pain, intermittent swelling or instability, for months, or even years, after the original sprain or strain.

Contact your GP if your injury doesn't improve as expected or your symptoms get worse. They may consider referring you to an orthopaedic specialist for further assessment and treatment.


Preventing sprains and strains

To help prevent sprains and strains, you should warm up properly before exercising and wear suitable footwear. Conditioning and strengthening exercises can also help.

Strengthening and conditioning

Including regular stretching and strengthening exercises as part of an overall physical conditioning programme can reduce your risk of sprains and strains by helping your joints stay strong and flexible.

If you're prone to sprains and strains, taping, strapping or wrapping your knees, ankles, wrists or elbows can help while you're recovering from injury and when you first get back into regular activities.

But for most people, taping, strapping or wrapping should only be a short-term protective measure. You can protect your joints in the long-term by strengthening and conditioning the muscles around them.

Read more about improving your strength and flexibility.

Wearing appropriate footwear

Always wear footwear that supports and protects your feet and ankles, whether you're at work, home or doing sport.

Also, make sure your footwear is appropriate to the type of activity you're doing, and that all of your shoes are in good condition. For example, avoid wearing shoes with a worn heel on one side because they may increase your risk of injury.

If you wear high-heeled shoes, you're more likely to sprain your ankle than if you wear flat shoes.

Read more about choosing sports shoes.

General advice

Follow the advice below to help prevent sprains and strains.

  • Warm up properly before you exercise and cool down properly afterwards.
  • Don't exercise or play sports when you're tired.
  • Take precautions against falling - keep stairs, walkways, gardens and driveways free of clutter, and in winter put sand or salt on icy spots outside your home.
  • Where possible, avoid running or walking on uneven surfaces.
  • Eat a healthy, balanced diet to help keep your joints and muscles strong.

Read more about how to warm up properly before you exercise and how to stretch after exercising.

 
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