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Health Questions & Answers #66 ~ [Issue 0705-4]  Wellness Weekly
 Jul 28, 2005 05:56 PDT 

Q & A #1:
What is the difference between a sprain and a strain?

A sprain is a stretch and/or tear of a ligament (a band of fibrous
tissue that connects two or more bones at a joint). One or more
ligaments can be injured at the same time. The severity of the injury
will depend on the extent of injury (whether a tear is partial or
complete) and the number of ligaments involved. A strain is an injury
to either a muscle or a tendon (fibrous cords of tissue that connect
muscle to bone). Depending on the severity of the injury, a strain
may be a simple overstretch of the muscle or tendon, or it can result
from a partial or complete tear.

Q & A #2:
What causes a sprain?

A sprain can result from a fall, a sudden twist, or a blow to the
body that forces a joint out of its normal position and stretches or
tears the ligament supporting that joint. Typically, sprains occur
when people fall and land on an outstretched arm, slide into a
baseball base, land on the side of their foot, or twist a knee with
the foot planted firmly on the ground.

Q & A #3:
Where do sprains usually occur?

Although sprains can occur in both the upper and lower parts of the
body, the most common site is the ankle. More than 25,000 individuals
sprain an ankle each day in the United States. The ankle joint is
supported by several lateral (outside) ligaments and medial (inside)
ligaments (see fig. 1). Most ankle sprains happen when the foot turns
inward as a person runs, turns, falls, or lands on the ankle after a
jump. This type of sprain is called an inversion injury. The knee is
another common site for a sprain. A blow to the knee or a fall is
often the cause; sudden twisting can also result in a sprain. Sprains
frequently occur at the wrist, typically when people fall and land on
an outstretched hand. A sprain to the thumb is common in skiing and
other sports. This injury often occurs when a ligament near the base
of the thumb (the ulnar collateral ligament of the
metacarpo-phalangeal joint) is torn.

Q & A #4:
What are the signs and symptoms of a sprain?

The usual signs and symptoms include pain, swelling, bruising,
instability, and loss of the ability to move and use the joint
(called functional ability). However, these signs and symptoms can
vary in intensity, depending on the severity of the sprain. Sometimes
people feel a pop or tear when the injury happens. Doctors closely
observe an injured site and ask questions to obtain information to
diagnose the severity of a sprain. In general, a grade I or mild
sprain is caused by overstretching or slight tearing of the ligaments
with no joint instability. A person with a mild sprain usually
experiences minimal pain, swelling, and little or no loss of
functional ability. Bruising is absent or slight, and the person is
usually able to put weight on the affected joint.

Q & A #5:
How are sprains and strains treated?

A. Reduce Swelling and Pain

Treatments for sprains and strains are similar and can be thought of
as having two stages. The goal during the first stage is to reduce
swelling and pain. At this stage, health care providers usually
advise patients to follow a formula of rest, ice, compression, and
elevation (RICE) for the first 24 to 48 hours after the injury (see
below). The provider may also recommend an over-the-counter or
prescription nonsteroidal anti-inflammatory drug, such as aspirin or
ibuprofen, to help decrease pain and inflammation.

For people with a moderate or severe sprain, particularly of the
ankle, a hard cast may be applied. This often occurs after the
initial swelling has subsided. Severe sprains and strains may require
surgery to repair the torn ligaments, muscle, or tendons. Surgery is
usually performed by an orthopaedic surgeon.

It is important that moderate and severe sprains and strains be
evaluated by a health care provider to allow prompt, appropriate
treatment to begin. This box lists some signs that should alert
people to consult their provider. However, a person who has any
concerns about the seriousness of a sprain or strain should always
contact a provider for advice.

B. RICE Therapy

Rest. Reduce regular exercise or activities of daily living as
needed. Your health care provider may advise you to put no weight on
an injured area for 48 hours. If you cannot put weight on an ankle or
knee, crutches may help. If you use a cane or one crutch for an ankle
injury, use it on the uninjured side to help you lean away and
relieve weight on the injured ankle.

Ice. Apply an ice pack to the injured area for 20 minutes at a time,
4 to 8 times a day. A cold pack, ice bag, or plastic bag filled with
crushed ice and wrapped in a towel can be used. To avoid cold injury
and frostbite, do not apply the ice for more than 20 minutes.

Compression. Compression of an injured ankle, knee, or wrist may help
reduce swelling. Examples of compression bandages are elastic wraps,
special boots, air casts, and splints. Ask your provider for advice
on which one to use, and how tight to safely apply the bandage.

Elevation. If possible, keep the injured ankle, knee, elbow, or wrist
elevated on a pillow, above the level of the heart, to help decrease

C. Begin Rehabilitation

The second stage of treating a sprain or strain is rehabilitation,
whose overall goal is to improve the condition of the injured area
and restore its function. The health care provider will prescribe an
exercise program designed to prevent stiffness, improve range of
motion, and restore the joint's normal flexibility and strength. Some
patients may need physical therapy during this stage. When the acute
pain and swelling have diminished, the provider will instruct the
patient to do a series of exercises several times a day. These are
very important because they help reduce swelling, prevent stiffness,
and restore normal, pain-free range of motion. The provider can
recommend many different types of exercises, depending on the injury.
A patient with an injured knee or foot will work on weight-bearing
and balancing exercises. The duration of the program depends on the
extent of the injury, but the regimen commonly lasts for several weeks.

Another goal of rehabilitation is to increase strength and regain
flexibility. Depending on the patient's rate of recovery, this
process begins about the second week after the injury. The provider
will instruct the patient to do a series of exercises designed to
meet these goals. During this phase of rehabilitation, patients
progress to more demanding exercises as pain decreases and function

The final goal is the return to full daily activities, including
sports when appropriate. Patients must work closely with their health
care provider or physical therapist to determine their readiness to
return to full activity. Sometimes people are tempted to resume full
activity or play sports despite pain or muscle soreness. Returning to
full activity before regaining normal range of motion, flexibility,
and strength increases the chance of reinjury and may lead to a
chronic problem.

The amount of rehabilitation and the time needed for full recovery
after a sprain or strain depend on the severity of the injury and
individual rates of healing. For example, a mild ankle sprain may
require up to 3 to 6 weeks of rehabilitation; a moderate sprain could
require 2 to 3 months. With a severe sprain, it can take up to 8 to
12 months to return to full activities. Extra care should be taken to
avoid reinjury.
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