Sprains – Causes, symptoms, treatment, and prevention

Stretching or tearing of ligaments can cause a sprain. Ligaments are fibrous tissue bands that connect two bones in the joints. Though they are different, people often use the terms sprain and strain interchangeably. In a sprain, the fibrous tissues that connect two bones get injured. On the other hand, a strain involves an injury to a muscle that attaches a muscle to a bone. Strain is a muscle-to-bone connector injury, whereas sprain is a bone-to-bone connector injury.

The sprain may result in the injury of one or more ligaments. Sometimes, the ligaments can be partially or completely torn and may need repair surgery. The sprain severity can range from ligament stretching to tear. The intensity of the sprain depends on the injury severity and the number of ligaments involved.

Where do sprains occur?

A sprain can occur in any joint, but the most vulnerable spots are the parts prone to falls and trauma. The most common areas for sprains are the ankle, knee, hand, and wrist.

• Ankle sprain:

It typically occurs when our foot turns inward while running, turning, or landing on the ankle after a jump.

• Knee sprain:

Typically occurs after a blow to the knee, a fall, or due to sudden twisting of the knee.

• Wrist sprain:

It occurs when we fall and put all body pressure on an outstretched hand.

What are the risk factors for sprains?

Anyone can suffer from a sprain, young or old, athletic or non-athletic. You may be at an increased risk if:

• You have a previous history of sprains
• You are overweight
• Poor physical condition
• You indulge in a lot of physical activities on uneven surfaces
• Constant stress on the muscles by overdoing exercise or athletic practice

What are the symptoms of sprains?

The sprain symptoms can vary from mild to severe, depending on the degree of muscle tear. The following are some predominant symptoms of sprain:

• Pain and tenderness
• Swelling in the area
• Stiffness
• Bruising
• Instability while walking, especially injury on weight-bearing joints like the knee or ankle.
• Limited range of motion of the affected joint

What are the causes of a sprain?

A sprain occurs when you tear a ligament while severely stressing or injury to the joint. Sprains can occur during the following conditions:

• Ankle — While walking, running, or exercising on an uneven surface, or improper landing from a jump
• Knee — Sudden rotation during an athletic activity
• Wrist — Landing on an extended hand during a fall
• Thumb —Overextension when playing sports, such as tennis
• Slipping or falling on slippery surfaces or uneven ground
• Taking a blow to the body that occurs due to a direct hit or a shift in balance.

Children are more likely to experience a fracture than a sprain, as they have growth plates (soft tissues near the ends of the bones) and the ligaments around a joint are generally stronger than growth plates, so the tear chances are low.

What are the risk factors for getting a sprain?

The following are some factors that contribute to sprains:

• Environmental factors - Wet or uneven surfaces increase the chances of developing a sprain.
• Poor equipment: Ill-fitting footwear or other sporting equipment may increase the risk of getting a sprain.
• Chronically tired muscles do not provide good support for your joints. Some people do not give rest and perform the activity and overexert the muscles, leading to a variable degree of sprain.

How can we diagnose a sprain?

• Physical assessment: Your doctor will ask about your complaint history and conduct a physical exam to see the extent of injury to the joint, which could have injured one or more ligaments. They also perform an examination for swelling, range of motion, and joint stability.
• Imaging tests: Orthopedics will advise you an X-ray to ensure there is no bone fracture. A doctor can not assess ligament injury or tear on an X-ray, but it is crucial to look at the joint spacing and to rule out a fracture.

Depending on the results exam and the body's response to initial treatment, the doctor can recommend higher imaging, like an ultrasound or MRI, to further evaluate the degree of injury.

What are the treatment modalities for a sprain?

The treatment of a sprain depends on the severity of the sprain injury. The sprain treatment depends on the degree of the injury and the number of ligaments injured. The following are the types of sprain injury:

• Mild or first-degree sprain: Involves minor stretching of the ligaments, causing minimal swelling and decreased range of joint movement.
• Moderate or second-degree sprain: Involves a combination of stretching and partial ligament tearing, leading to swelling, pain, and difficulty bearing weight.
• Severe or third-degree sprain: It may involve a complete ligament tear and rupture, causing severe pain, bruising, swelling, and joint instability.

The doctors advise following the PRICE method in the first 24 to 48 hours after the injury. PRICE stands for:

• P- Protection: Keep the injurious area intact. Do not put weight or pressure on the injured area to prevent further movement. The doctor may advise a brace, splint, or crutches to stay off the injured area.
• R- Rest: An injury like a sprain requires a lot of rest to let the area heal. Restrict activities that cause pain or discomfort.
• I- Ice: Apply an ice pack to the injured area for at least 20 minutes. You can do this 4 to 8 times a day. You can also use a chilled cloth, ice bag, or ice wrapped in a towel. If the areas feel numb or uncomfortable, you can immediately stop icing.
• C- Compression: Compression or continuous pressure on the injured area aids in swelling reduction. You can reduce swelling by compressing it with an elastic bandage. Avoid wrapping the compressing bandage too tightly, as it may hinder blood circulation. It is essential to loosen the wrap if the pain increases and the area becomes numb or swollen.
• E- Elevation: The doctors suggest elevating the injured area above the level of your heart, especially during nighttime. The elevation is a great technique that allows gravity to help reduce swelling.

Do you need surgery for a sprain?

Depending on the severity, sometimes the doctor may recommend surgery for a sprain. Orthopedics recommend a surgery after a thorough evaluation of the injury and determining the healing potential with and without surgery. Other factors affecting recovery include age, activity level, and risk factors involved with surgery.

Is physical therapy necessary to recover from a sprain?

Healthcare professionals advise physiotherapy after a sprain to fasten healing. The intensity of the sprain will determine the steps needed for the recovery process. A physiotherapist will formulate a program for you depending on the severity of your sprain injury. Properly designed physiotherapy exercises will help regain joint strength and mobility.

Additionally, physiotherapists will recommend a home exercise program according to your conditions to prevent the injured joint from becoming stiff. A home exercise program will involve exercises to build strength and balance to recuperate the injury. Physiotherapy can help you build joint strength and stability, making the affected joint even stronger than it was. If you have suffered repeated sprains or were immobilized for a long time, the doctors strongly recommend physiotherapy to reduce the chance of getting injured again.

What is the recovery period from a sprain?

The recovery period is directly proportional to the severity of the injury. In mild sprains, the recovery period will be for a few weeks. In severe cases, it could take up to 12 weeks to recover. In the cases of complete ligament tear, the doctors recommend surgical repair, and the recovery period will be the longest. The healthcare specialists may design a surgery, healing, and return-to-activity plan following surgery for smooth recovery.

How can we prevent getting sprained?

The following are some helpful tips to reduce the risk of getting a sprain:

• Performing regular stretching and strengthening exercises to build the core strength of the muscles.
• You can protect your joints in the long term by strengthening the muscles around the previously injured joint.
• Ensure you wear footwear that provides support and protection.
• Do not try to exercise or play sports when you are in pain or discomfort.
• Maintain a healthy weight and well-balanced diet to keep your muscles strong.
• Practice safety measures to prevent falls.
• Perform warm-up and stretching for 10-15 minutes before any physical activity.

When to see a doctor

Sprain healing will take time, but if you are experiencing any of the following symptoms, immediately contact your doctor:

• If you are unable to move or bear weight on the affected joint
• If you have severe pain, swelling, or redness directly over the injured joint
• Numbness or tingling sensation in the injured area
• If you have an injury in a joint with a history of injury

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