What are sprains and strains?
Sprains and strains are a common type of injury that affect muscles and ligaments.
Ligaments are strong bands of tissue around joints that connect one bone to another. They help to keep bones together and stable.
Symptoms of sprains and strains include:
- swelling and inflammation
- loss of movement in the affected body part
A sprain occurs when one or more of your ligaments have been stretched, twisted or torn, usually as a result of excessive force being applied to a joint. The most common locations for a sprain to occur are:
- the knee – which can become strained when a person turns quickly during physical activities
- the ankle – which can become strained when walking or running on an uneven surface
- the wrist – which can become strained when a person falls onto their hand
- the thumb – which can become strained during repetitive physical activity (such as playing a racquet sport) or a fall
A strain occurs when the muscle fibres stretch or tear. They usually occur when the muscle has been stretched beyond its limits or it has been forced to contract (shorten) too quickly.
Strains can develop as the result of an accident, or during physical activities, such as running or playing football.
Read more about the causes of sprains and strains.
The most common types of strains are:
- hamstring strains – the hamstrings are muscles that run down the back of the leg and are connected to the hip and knee joints
- gastrocnemius and soleus strains – the gastrocnemius and soleus are the medical name for the muscles of the calf
- quadriceps strains – the quadriceps are muscles located at the front of the thigh
- lumbar strains – the lumbar muscles are found in the lower back
Treating a sprain or strain
Most sprains and strains can usually be treated with self-care techniques, such as PRICE therapy – protection, rest, ice, compression and elevation. doctor if you are in severe pain, or if the injury is not improving or is getting worse.
Painkillers can be used to help ease any pain, and stronger ones may be prescribed if you have a serious injury.
Most people will be able to resume normal activities within six to eight weeks. Severe muscle strains may take longer.
Preventing sprains and strains
There are a number of ways you can help to prevent sprains and strains, including:
- using the correct footwear for activities
- warming up properly before exercise
- stretching or 'warming down' after exercise
- doing regular strengthening and conditioning exercises
Read more about preventing sprains and strains.
How common are they?
Sprains and strains are very common.
Strains and sprains symptoms
Symptoms of a sprain or strain depend on how severe the injury is. They often include pain, swelling and tenderness.
Common symptoms of a sprain include:
- pain around the affected joint
- being unable to use the joint normally or being unable to put weight on it
The swelling from a sprain will often occur soon after the injury. However, the bruising may not show until some time later or it may not show at all. Bruising can sometimes occur some distance from the affected joint, as blood from the damaged tissue seeps along the muscles and around the joint before coming close to the skin.
The symptoms of a muscle strain will depend on how severe the injury is. Symptoms can include:
- pain in the affected muscle
- muscle spasms (when the muscles contract tightly and painfully)
- loss of some, or all, of the function in the affected muscle
- blood collecting under the skin at the site of the strain – this is known as a haematoma and it looks like a large, dark-red bruise
Grading sprains and strains
There are two grading systems used to assess how serious a sprain or strain is.
The grading system for sprains uses a series of grades from one to three:
- Grade one sprain – mild stretching of your ligament has taken place.
- Grade two sprain – there has been a partial rupture (splitting) of your ligament but the joint it is associated with is still stable.
- Grade three sprain – there has been a complete rupture of the ligament and the joint is unstable.
The grading system for muscle strains uses a series of degrees:
- First degree strain – mild straining of the muscles fibres where only a few fibres have been stretched or torn. The muscle will be painful and tender, but you should still be able to use it normally.
- Second degree strain– a greater number of fibres have been stretched or torn. You will experience more severe pain and tenderness and there may also be mild swelling and bruising.
- Third degree strain– the muscle has been split into two or torn away from its tendon (a band of tissue that connects a muscle to a bone). You will lose all use of the affected muscle.
When to seek medical help
You should visit your doctor or another healthcare professional if you have a sprain or strain and:
- you have severe pain and cannot put any weight on the injured joint or muscle
- the injured area looks crooked or has lumps or bumps (other than swelling) not usually present
- you cannot move the injured joint
- the limb gives way when you try to use the joint
- you have numbness in any part of the injured area
- the pain has not improved after four days of self-treatment
Causes of sprains and strains
The main causes of sprains and strains are sporting activities or accidents that involve a fall or collision.
Sprains or strains are most likely to occur if you:
- change direction suddenly
- slow down or accelerate suddenly
- fall and land awkwardly
- collide with an object
Ankle sprains can occur if you lean onto the outside of your foot. This causes your whole body weight to press down suddenly on the outer ligament of your ankle which can stretch or tear it. Ankle sprains sometimes occur when walking or running over rough or uneven ground.
Sprains and strains often occur when playing sports, because of the physical contact and sudden acceleration and deceleration involved in sports.
Sports injuries often occur when someone begins to take part in a sport for the first time and their muscles are not used to the physical stresses involved.
Alternatively, experienced athletes may injure themselves when they are 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 due to the intense nature of their training and the overuse of specific muscle groups.
Children are also at risk of getting sports injuries because they are still developing physically. However, while there is an increased risk of injury when playing sports, it is important to remember that they also have important health benefits and can help increase a child’s confidence and self-esteem.
Read more about sports injuries.
There are a number of things that make you more likely to develop an injury. These are described below.
- Poor conditioning – a lack of regular exercise can make your joints less flexible and more likely to sustain injury.
- 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.
- Fatigue – when your muscles are tired, they are less likely to provide good support for your joints. When you are tired you may also find it difficult to control your body's movements accurately, which increases your likelihood of stressing or over-extending a joint.
- Inadequate warm up – warming up before exercise helps loosen your muscles and increases your range of joint movement, lowering your risk of sustaining a ligament injury. Not warming up properly before exercising increases your risk of injury.
Read more about preventing sprains and strains.
Diagnosing strains and sprains
When diagnosing a strain or sprain, your doctor will ask about how you injured yourself and will perform a physical examination. In severe cases, an X-ray may be needed.
Your doctor will want to know about treatments you have already tried, as well as any medication you are currently taking that could affect the injury, such as anticoagulants (blood-thinning medication).
The affected joint or muscle will be examined to assess how severe your injury is. 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 will also assess:
- how much you can move the injured joint or muscle
- whether you are 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.
Most people with sprains and strains do not need to have X-rays. However, your doctor may recommend an X-ray if:
- you are unable to put any weight on your ankle, foot or leg
- there is tenderness of the bones at specific points on your ankle, foot or leg
- you have difficulty moving your knee
Your doctor may also recommend an X-ray if you are over 55 years of age, and have an acute knee injury (see below). The reason for this is that people over the age of 55 have a higher risk of developing a fracture after this type of injury.
An acute knee injury is where the knee joint receives a sudden blow, or is damaged in some other way, such as being suddenly twisted out of position.
Treatment for sprains and strains
Most mild to moderate sprains and strains can often be treated at home using self-care techniques. Painkillers can also be used to ease pain.
Self-care techniques after a minor sprain or strain include:
- PRICE therapy
- avoiding HARM
These are described in more detail below.
PRICE stands for protection, rest, ice, compression and elevation.
- Protection – protect the injured 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 injured joint or muscle. Avoid activity for the first 48 to 72 hours after injuring yourself. Your doctor 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. Do not leave the ice on while you are asleep, and do not 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 crepe bandage or a simple elastic bandage available from a pharmacy. It should be wrapped snugly 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 having long periods of time where your leg is not raised.
For the first 72 hours after a sprain or muscle strain you should avoid HARM. This means that you should avoid:
- Heat – such as hot baths, saunas or heat packs (applying a controlled amount of heat to affected joints)
- Alcohol – drinking alcohol will increase bleeding and swelling and decrease 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 should not stop using a sprained joint because the injury will heal quicker if you begin to move the joint as soon as you are able to.
Your doctor will be able to teach you a range of exercises that will help you to improve the function of the joint.
An exception may be made in cases of severe ankle sprains. Studies have found people whose ankle joint was immobilised for 10 days with a short cast recovered normal ankle function quicker than those who were treated using exercise soon after the injury occurred.
Immobilising strained muscles
The advice for muscle strains can be different. Depending on your injury, you may be advised to keep your injured muscle still for the first few days. Your doctor may arrange for 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 will probably be advised to start using the muscle again.
Paracetamol is usually recommended for painful sprains or strains. If this does not help, a stronger painkiller, such as codeine, only available on prescription, may be required.
Oral non-steroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen can also help reduce swelling and inflammation. However, NSAIDs should only be considered 48 hours after the injury has occurred because they affect the healing process.
Your doctor may also prescribe an NSAID cream or gel, such as ibuprofen or ketoprofen, to help treat pain. You should 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). Avoid exposing areas of your skin to which you have applied cream or gel to direct sunlight or artificial sources of light, such as sunlamps or sun beds.
Your doctor may ask to see you after a few days to assess how well your injury is healing.
It is also recommended you contact your doctor if:
- your sprain or strain does not improve as expected – for example, you still find walking difficult
- your symptoms get worse, such as increased pain or swelling
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 will probably be able to walk one to two weeks after the injury. You may be able to use your ankle fully after six to eight weeks and you will probably be able to return to sporting activities after eight to 12 weeks.
In cases of muscle strains, the time it can take to return to sporting activities can range widely, from two weeks to six months.
Strains and sprains complications
Complications of a sprain or strain can include a fracture, dislocation or muscle and tendon injuries that need treatment in hospital.
If you have a sprain or strain with a lot of bruising and swelling it may indicate the bone is fractured (broken). Other signs of a fracture can include:
- lumps and bumps not usually there
- being unable to bear weight
- pain or tenderness in a different place – for example, if you have sprained your ankle, but also have pain in your leg
Read more information about:
Dislocated joints can also be a complication of sprains and strains.
Pain and recurring swelling can be common complications after an ankle sprain, particularly on the outer (lateral) side of the ankle.
If you are unable to use or tighten a strained muscle it may mean a tendon attached to the muscle is ruptured.
If you twist your knee and feel a tearing sensation followed by severe pain, it could be a cartilage injury.
Referral to hospital
If your injury has complications, your doctor may refer you to:
- the accident and emergency department of your local hospital
- an orthopaedic specialist (a doctor who specialises in conditions that involve the skeleton, joints and muscles)
You may be referred to A&E or a specialist if you have:
- a suspected fracture or dislocation
- nerve or circulation damage
- a ruptured tendon
- a wound entering into the joint
- a bleeding disorder or a history of deep vein thrombosis (DVT)
- signs of bacterial infection in a joint (septic arthritis), bleeding into a joint (haemarthrosis), or a large blood clot in a muscle (intramuscular haematoma)
- a completely torn muscle, or more than half of it is torn
Your doctor may also refer you to an orthopaedic specialist if your condition does not improve as expected.
Preventing strains and sprains
There are several ways you can help prevent sprains and strains such as warming up properly before exercising and wearing suitable footwear.
Strengthening and conditioning
Regular stretching and strengthening exercises as part of an overall physical conditioning programme can help reduce your risk of sprains and strains. Regular exercise will help joints stay flexible and reduce the likelihood of injury.
If you are prone to sprains and strains, taping, strapping or wrapping your knees, ankles, wrists or elbows can help while you are recovering from injury and when you first get back into regular activities.
However, for most people, it is best to regard taping, strapping or wrapping as a short-term protective measure. You can protect your joints in the long-term by strengthening and conditioning the muscles around them.
You should always make sure you wear footwear that supports and protects your feet and ankles whether you are:
- doing sport
- at work
- at home
If you wear high-heeled shoes, you are more likely to sprain your ankle than if you wear flat shoes.
Read more information about [choosing sports shoes].
You can help prevent sprains and strains by following the advice listed below.
- Warm up properly before you exercise and cool down properly afterwards.
- Avoid exercising or doing sporting activities when you are 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.
- Do not wear shoes that have a worn heel on one side.
- Avoiding running or walking on uneven surfaces.