Strains/Sprains

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What's the difference between a strain and a sprain?

When you strain or "pull" a muscle, you've stretched the muscle tissue or the tendon that connects it to a nearby bone. Strains usually happen in your neck, back, thigh, or calf muscles. Sprains, on the other hand, happen to joints. When you sprain your ankle, knee, wrist, or elbow, you've stretched or torn a ligament, the tough elastic tissue that connects the bones of the joint. Both kinds of injury will cause sharp, immediate pain. You may hear a pop or snap when you sprain a joint, which will be followed by swelling and sometimes bruising caused by ruptured blood vessels. The faster the swelling, the more severe the injury. If you feel intense pain or if you're unable to put any weight on an injured joint, you may have severed the ligament and should see a doctor.

How do these injuries occur?

Most people pull muscles in their back or necks when they try to pick up something heavy without bending their knees and keeping their back straight. You can pull muscles in your legs when you push them too hard by breaking into a sprint, for instance, or squatting under a heavy barbell without warming up first. Ankle sprains usually occur when your ankle rolls outward and the ligament connecting the knobby part of the bone to the foot's outer surface gets stretched or torn. This happens most often when you're playing a sport that requires you to move quickly from side to side, such as tennis or basketball, but you can also turn your ankle while stepping off a curb or hiking on a rough trail. You're most likely to sprain your knee by landing wrong after a jump in a sport like volleyball, gymnastics, or basketball, or by wrenching it out of alignment during a fall on the ski slope. You might stretch or tear ligaments in your wrist or elbow if you try to break a fall with an outstretched arm, forcing those joints to absorb your full weight.

How can I avoid strains and sprains?

The simplest thing you can do is wear the right shoes and protective gear for any sport you play. Running shoes, for example, aren't good for hiking or tennis because their extra cushioning makes the base slightly more elevated and less stable. When you hike, be sure to wear boots that lace up over the ankles and support them, especially if you're carrying a pack that weighs more than 20 pounds. And remember that you're destined to take a few spills while learning a sport like in-line skating or snowboarding, so wear protective wrist and elbow pads (along with knee pads and a helmet) to protect those joints when you do.

It's also crucial to warm up before a workout, by, say, jogging or riding an exercise bike at a moderate pace for at least five minutes. Light aerobic activity will literally heat up your muscles and ligaments, making them more pliable and less prone to tearing. You may also want to spend a few minutes stretching after a workout; this will improve the flexibility of your joints and muscles, which can get stiff from exertion. Over the long run, regular exercise and weight lifting can help you avoid strains and sprains by strengthening your muscles, keeping your joints limber, and improving your balance and coordination so that you're less likely to roll your ankle or take a fall. If you're just beginning an exercise program, start out slowly and increase the intensity as you build strength and endurance.

And finally, sticking to a nutritious and well-balanced diet will help keep your muscles strong, while maintaining a healthy weight will keep extra strain off your joints.

How should I treat a strain or sprain?

Unless the tissue is severed, you can usually treat strains and sprains at home. For hints on how to reduce the pain and swelling, remember the acronym RICE, for "rest, ice, compression, and elevation." Rest the injured area as much as possible for 24 to 48 hours. Use crutches to take the weight off a hurt knee or ankle; support a sprained elbow or shoulder for a few days with a sling. Apply a cold pack (or a bag of frozen peas) for 10 to 15 minutes at a time, but wrap it in a damp towel first to avoid giving yourself frostbite. Do this as soon after you get hurt as possible, and repeat at least three times a day for a day or two. Keep excess fluid from accumulating around a sprained joint by compressing and elevating it. Starting below the joint, wrap an elastic bandage loosely, so that your circulation isn't cut off. Elevate the injured area above the level of your heart by propping it up on pillows when you're sitting or lying down. Take anti-inflammatory pain relievers like ibuprofen, too.

After the pain and swelling are gone, which may take a week or more, you can slowly start resuming normal activity. First try moving the joint around (stop if it hurts). Once you can move it without pain, start strengthening the muscles around it. A physical therapist can tell you which exercises are best for this. When you're ready to get moving again, choose an activity that doesn't put any stress on the injured area, such as swimming.

When should I see a doctor?

Moderate and severe sprains and strains should be evaluated by a doctor promptly so that he or she can get you started with the appropriate treatment. Don't hesitate to see your doctor if you have any doubts about the seriousness of your injury or how to care for it. Specifically, go to a doctor if you have any of the following symptoms: severe pain or a buckling of the limb when you put even a little weight on the injured area or try to use it, the appearance of lumps (other than swelling) or crookedness along the injured joint or muscle, extreme tenderness to the touch, the inability to move the injured joint or muscle, any numbness in the injured area, or any redness or red streaks spreading out from the injury.