Let me set the stage: it’s a sunny Summer day and you decide to go for an early morning jog. You down your coffee, slip on your running shoes, and head out the door. A few minutes later you are cruising along the trail, lost in your thoughts when an enthusiastic dog darts out toward you. You suddenly snap out of your daydream and dodge the happily bounding dog, but while doing so, you plant your foot in a less than optimum way and feel a pain that reminds you of that time you sprained (or strained?) your wrist playing hockey.
Later that day you stop in at the walk-in clinic to have a medical professional look at your slightly swollen and achy ankle. The doc says not to worry about it, it is just a strain (or was it a sprain?). Take it easy and you should be good to go after a few days rest and RICE. Phew!
The Difference Between a Strain and a Sprain
Sprains and strains both refer to damage to the soft tissues in the body, including ligaments, tendons, and muscles. They are both common injuries, for those of us who use our bodies in new and exciting ways each day, and they both share some common symptoms. What it comes down to is which soft tissue—ligament or tendon—has been affected.
The difference is which soft tissue—ligament or tendon—has been affected.
A ligament is a tough band of fibrous tissue that connects bones to other bones or cartilage and is usually located around joints. A tendon is a tough cord of fibrous tissue that connects muscles to bones. And that, right there, is the main differentiating factor.
- A sprain is an overstretched, torn, or twisted ligament. Commonly sprained areas include the wrists, ankles, thumbs, and knees.
- A strain is an overstretched, torn, or twisted tendon or muscle. Commonly strained areas include the legs, knees, feet, and back.
Is this an important distinction to make? Well, honestly, not really. At least not for us laymen. But it does matter to the medical professional who is giving advice on how to treat, manage, or heal that tender ankle.
How Muscles and Tendons Get Strained
In an oversimplified nutshell, the muscles you have doing all that work underneath your skin are made up of a large number of smaller bundles of muscle fibers called fascicles. These fascicles are made up of individual muscle fibers that are all crosslinked so they can slide back and forth inside the fascicle.
Gradually, near the ends of the muscle, these muscle fibers turn into tendon fibers and then attach to the bone. Each tendon is different, depending greatly on its location in the body, and a tendon can range from being pretty short to pretty darn long.
Strain Causes
A strain occurs when damage is caused by an overstretched muscle or tendon, pulling their fibers apart, and therefore losing the ability to adequately contract. The severity of strain depends on whether the muscle fiber is just over-stretched, partially torn, or completely torn. The strain (or damage) can occur in three areas: the muscle itself, the intersection where muscle fibers turn into tendon fibers, or right in the tendon itself.
A strain can occur from one single wipeout or incident, or it can gradually build up over time and repeated use. The most common strain is from overuse (repetitive use injury) but muscles and joints can also be acutely forced to do things that they are not prepared or designed to do and that can also result in a strain.
Strains happen while playing sports or other activities that involve repetitive movements, sitting or standing in an awkward position for a prolonged time, lifting a heavy object, or simply slipping and falling.
A strain can occur from one single wipeout or incident, or it can gradually build up over time and repeated use.
Strain Grades
- Grade 1: stretching of a few of the muscle fibers.
- Grade 2: muscle fibers are damaged or torn.
- Grade 3: complete rupture of the muscle. Ouch!
Strain Symptoms
- Swelling
- Bruising
- Limited mobility
- Pain or tenderness
- Muscle spasms or cramping
- Muscle weakness
How Joints and Ligaments Get Sprained
The joints in our bodies are stabilized by bands of tissue called ligaments. These ligaments allow the joint to move in some directions and not in other directions - although there are some joints that move on multiple planes. Ligaments are anchored to bone on each side of the joint.
Sprain Causes
A sprain usually occurs rather suddenly and is most often located in the area right around a joint. When a ligament is stretched too far or torn, that is when the doctor tells you that you have a sprain. Sprain symptoms can range from mild to severe depending on how many tissue fibers were affected by the mishap.
Sprains happen most often when the joint moves out of its normal range of movement, tearing or stretching the ligament. This can happen when you are simply walking or running on an uneven surface, playing a sport where you are twisting or pivoting repeatedly, falling and landing on your outstretched hand, or being knocked off balance while playing a contact sport.
A sprain usually occurs rather suddenly and is most often located in the area right around a joint.
Sprain Grades
- Grade 1: fibers of the ligament are stretched but not torn.
- Grade 2: ligament is partially torn.
- Grade 3: ligament is completely torn or ruptured. Ouch!
Sprain Symptoms
- Limited mobility
- Pain
- Swelling
- Bruising
- Inability to bear weight
- There may be "popping" sensation when the injury happens
How to Tell the Difference
Generally speaking, the treatment for sprains, strains, and tears are pretty similar so it isn’t all that important to know exactly which one you have (kind of like a cold vs a flu). But it is important to rule out severe tears and broken bones so doctors often diagnose a sprain or strain by eliminating these other causes. So, after giving you and your injury a physical exam, your doc may send you for an X-ray to rule out dislocations or fractures.
The treatment for sprains, strains, and tears are pretty similar, so it isn’t that important to know exactly which one you have.
Depending on the severity (and what the X-ray showed) your doc may also request an MRI. An MRI gives a very detailed view of the joint and could reveal things that are otherwise impossible to find.
In the end, if the MRI and the X-ray don’t reveal anything (like breaks or tears), the doctor will likely diagnose you with a sprain or strain and send you on your way, hopefully with a treatment plan in your hand or at least in your head.
Treatment Plan: RICE
It is generally prescribed that you follow a four-step RICE protocol, whether you have a sprain or a strain. This protocol is said to help reduce swelling and also to relieve pressure on the affected area.
RICE is an acronym for Rest, Ice, Compression, and Elevation. But this can be misleading in its seeming simplicity, so let’s break it down.
Rest
It is important to rest the affected area and protect it from excessive stress, but that does not mean that it should be kept completely inactive! Not moving or using the area at all can result in major decreases in both strength and mobility, as well as promote more swelling. Whatever movement you do with that area must be within the capacity of the affected tissue, so as not to cause further injury or negatively affect the recovery of the affected tissue. Let pain be your guide—don’t be a hero but also don’t be a wimp.
Ice
Apply ice for 15 to 20 minute periods every few hours for about 48 hours after the injury occurred. Wrap the ice in a damp towel or cloth so you don’t cause superficial nerve or skin damage by placing the ice directly on your skin. In that first 48 hours, ice can decrease the swelling, reduce pain, and reduce muscle spasms. After 48 hours ice can actually become less effective and cause some less desirable reactions like a decrease in local metabolism and enzymatic activity, and reduced flexibility and elasticity of the connective tissue of the muscles.
Pro-tip: After about 72 hours has passed, heat will actually do more for you than ice. Heat will increase circulation to the area, relax muscle tension, and reduce joint stiffness.
Compression
This helps immobilize and protect the joint and also helps further reduce the swelling by adding pressure to the tissue. You can use a bandage, a brace, tape, or compression garments for this.
Elevation
The injured limb or area should be elevated to the same level (height) as the heart which maximizes the power of the circulatory system. With the injured area at the same level as your heart (and not above it), the body can effectively reduce the pressure in the injured area and allow cellular waste products to be removed. This can help the injured tissue re-establishing cellular and extracellular homeostasis.
How to Prevent a Strain or Sprain
As they say, the best offense is a good defence. Before we finish up, here are some quick and dirty ways you can prevent a strain or sprain. For more tips, make sure to check out the article How to Avoid Exercise Injuries for more injury prevention tips.
- Strengthening training: Regular resistance training sessions mixed with stability exercises (or pre-hab) can allow you to build a robust framework which can help prevent injuries.
- Warm-up properly: Warming up the muscles with full body movements and dynamic (not static) stretching increases the range of movement and prepares the body for what you are about to ask it to do.
- Don’t forget your feet: Much of our movement starts and is anchored in our feet, which makes them one of the most important areas to take care of (along with your core). Shoes with appropriate support can help to protect your ankle and knee joints but not nearly as well as having strong and supple feet. Check out the article called 5 Ways to Get Stronger Feet for more info on that.
- Always stay aware of your environment: Keep your wits about you! It is tempting to slip into a world of your own when you are on a long run or ride, but always beware of slippery or uneven surfaces. Keep an eye out for obstacles (like a darting child or pet) that could pop out at you, and of course the other players on the rink, court, or field with you.
Of course, not all injuries, whether they be a sprain or a strain, are preventable. But doing your best to prevent them also means that you are doing your best to minimize the impact of those unavoidable circumstances.
For more injury info, prevention tips, and to join the strained conversation, head over to Facebook.com/GetFitGuy or twitter.com/getfitguy. Also don't forget to subscribe to the Get-Fit Guy podcast on Apple Podcasts, Stitcher, SoundCloud, Spotify, Google Play or via RSS.
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