SPRAINS & STRAINS (Pulled Muscle)

General Information

DEFINITION--A sprain is a stretched or torn ligament. A strain is a stretched or torn muscle or tendinous attachment. Sprains occur most often in ankles, knees, wrist or fingers, although any joint can be sprained. Sprained joints can function, but only with pain.

BODY PARTS INVOLVED--Muscles, tendons and any ligament attached to any joint. Ligaments are the fibrous, elastic connective bands that attach bone to bone (tendons connect muscle to bone).

SEX OR AGE MOST AFFECTED--Both sexes; all ages.

SIGNS & SYMPTOMS

• Pain or tenderness in the area of injury; severity varies with the extent of injury.
• Swelling of the affected joint.
• Redness or bruising in the area of injury, either immediately or several hours after injury.
• Loss of normal mobility in the injured joint.

CAUSES--Strains usually are associated with overuse injuries. Sprains usually occur secondary to trauma (fall, twisting injury or automobile accident). The ankle is injured most often because of its anatomical weakness, its exposed position and the stress it sustains in athletic and recreational activities. It is difficult to differentiate sprains from strains.

RISK INCREASES WITH

• Trauma.
• Excessive exercise; poor conditioning; obesity.
• Poor fitting shoes and high heeled shoes.
• High risk activities (skateboarding), contact sports, ice and roller skating.

HOW TO PREVENT

• Maintain good level of physical fitness.
• Wrap weak joints with support bandages before strenuous activity.
• Stretch muscles before and after exercise.
• Strengthen weak muscles with rehabilitative exercises to prevent a recurrence.
• Accident-proof your home.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Depending on the extent of the injury, x-rays of the injured area, CT scan or MRI (See Glossary for both).

APPROPRIATE HEALTH CARE

• Self-care if the injury is not severe.
• Doctor's treatment if the joint cannot move or bear weight normally.
• Surgery may be necessary to repair badly torn ligaments.
• A cast may be necessary for severe sprains or following surgery. Following cast removal, you will wear support bandages for a while. Air cast type devices are very effective.

POSSIBLE COMPLICATIONS

• Permanent weakness if the sprain is severe or if a joint is sprained repeatedly.
• Arthritis.

PROBABLE OUTCOME--With appropriate treatment and rest, 6-8 weeks for recovery. May take longer depending on severity of the injury.

How To Treat

GENERAL MEASURES--

• RICE therapy-rest, ice, compression, elevation.
• Apply ice to the injured joint during the first 24 hours. Place ice in a plastic bag and separate it from the skin with a thin towel. Hold it against the joint with your hand or an elastic bandage. Keep the ice pack on the joint up to 2 hours at a time either constantly or intermittently depending on your ability to tolerate the cold. Continue the ice treatment at 2-hour intervals for 24 hours.
• After 24 hours, may continue ice treatment or switch to heat.
• To use heat, soak the joint in hot water or apply heat for 15 minutes every 2 hours or whenever possible. Don't apply heat during the first 24 hours. It may increase bleeding and swelling and prolong healing time.
• Compression with an elastic (Ace) bandage.
• Whenever possible, elevate the joint (especially while sleeping) so fluid can drain and diminish swelling.
• Learn how to use crutches, if needed.

MEDICATION--You may use non-prescription pain relievers such as acetaminophen or ibuprofen. If the sprain is severe, your doctor may prescribe a stronger pain reliever.

ACTIVITY--

• Allow the joint to rest 1 or 2 days. Then begin exercising the joint gently, without putting weight on it.
• Physical therapy may be recommended to regain strength and normal use of the joint.

DIET--No special diet.

Call Your Doctor If

• You have a sprained joint that won't bear weight or move normally.
• Pain becomes intolerable.
• Swelling or bruising increases, despite treatment.