Sprain or Strain

Sprain and Strain are often used interchangeably, but there is a difference. The simplest answer is that a strain involves damage to a tendon and a sprain involves damage to a ligament. Using the correct terminology helps accurately describe the structure involved, determine recovery time, and help select appropriate treatment. Also, understanding the mechanism of injury and the symptoms experienced may help accurately diagnose a problem as a sprain or strain.

A sprain is an injury that affects one or more ligaments. A ligament is defined as a thick cartilage band that attaches one bone to another bone. Examples include the anterior talofibular ligament of the ankle which holds together two bones of the ankle, or the anterior cruciate ligament (ACL) in the knee. The role of a ligament is to provide stability and restrict movement. In the example of the ACL, it restricts the tibia from moving anteriorly on the femur. Sprains may be graded according to severity. A grade I sprain is considered mild and may result in some overstretching and damage to the fibers of the ligament. A grade II sprain is moderate and involves partial tearing of the ligament. A grade III tear is severe and results in a complete tear of the ligament. Location of pain, severity, and functional loss may help hypothesize the severity and grade of a sprain.

A strain is an injury that affects a tendon. A tendon is defined as a band of fibrous tissue that connects a muscle to its bony attachment point. Examples include the Achilles tendon which attaches the calf to the heel, or the tendons of the rotator cuff which serve several functions for optimal shoulder function. Tendons are responsible for movement of the body. In the example of the Achilles tendon, the calf muscle contracts, therby pulling on the tendon that is attached at the heel and creating movement. This allows for pushing off during ambulation. Generically, tendon injury is coined tendonopathy. Contrary to popular belief, not everything can be classified as tendonitis. Tendons may be injured in different ways such as: rupture where tearing occurs and preceded by degeneration, paratenonitis where inflammation dominates and may be due to overuse, and tendinosis where degeneration occurs without inflammation.

Treatment for sprains generally involves gentle stretching, strengthening exercise to create stability, possible bracing, and surgery in severe cases. Ligaments tend to have a limited blood supply, therefore healing may take longer than other areas of the body.

The expected outcome is good with people often able to return to any activity they desire. Things such as severity, age, level of conditioning, strength, and general health can all influence recovery, but generally people can start to feel pretty good within 4-6 weeks.

Treatment for a rupture often involves respect to healing time, protection early on from overloading, and stretching and strengthening in later phases. Paratenonitis is best treated by minimizing and stopping inflammation. Ice, antiinflammatories, and injections often help. Tendinosis is best treated with certain types of soft tissue mobilization and exercise to improve collagen synthesis and tendon mobility.

The expected outcome for tendonopathies is good with proper treatment and basing treatment on type of tendon problem. In tendinosis, people need to progress cautiously. Return to vigorous activity can take 6-9 months.