Understanding and Managing Joint Sprains and Strains: A Comprehensive Guide

Physical activity, while good for you, can result in the occasional injury.  Joint sprains and strains are among the most common injuries affecting individuals of all ages, often causing discomfort and limiting mobility.  While they tend to present similarly and are often referred to interchangeably, they actually represent two different injury types. 

This comprehensive guide delves into the nuances of these injuries, providing readers with an in-depth understanding of their causes, symptoms, how to distinguish between them, as well as treatment options. Whether you’re an athlete, a fitness enthusiast, or someone dealing with the everyday wear and tear of life, this article offers valuable insights and practical advice to help you manage and recover from joint sprains and strains effectively. 

What Are Sprains and Strains? 

Sprains happen when ligaments, the tissues connecting bones to each other at a joint, become stretched or torn (1). This can happen from something as simple as falling or twisting wrong, but can also occur when any type of impact occurs. Sprains will result in pain, swelling, bruising, and difficulty moving the joint. Depending upon the severity of the sprain as well as the location, some individuals may even feel a pop or tear. While sprains can happen anywhere ligaments exist in the body, they are most commonly found in the wrists and ankles due to the high level of movement in those joints as well as their frequent, day to day usage. All sprains are divided into degrees to indicate the severity of the injury, from first degree (a minimally stretched ligament) to third degree, which results in a complete tear in the affected ligament (2). 

Strains on the other hand, happen when a muscle or tendon, the tissue that attaches muscles to bones, becomes overstretched or torn. Like sprains, strains can occur at differing levels of severity; typically divided into Grades I, II, and III, these injuries are classified based on the levels of pain, swelling, and bruising. Additionally, while sprains typically happen suddenly, strains can occur either suddenly or over a period of time. Individuals who play sports tend to be more susceptible to strains, particularly in the back and hamstring. If a muscle or tendon is strained, the individual will likely experience pain, muscle spasms, swelling, and trouble moving the affected area.  

The key difference between strains and sprains is in the tissues that are affected: 

• Sprains will occur only in ligaments and will tend to occur in joints, specifically. 
• Strains, however, can affect the muscles or the tendons and can occur anywhere. 

Common Causes and Risk Factors 

Both sprains and strains carry similar causes and risk factors, including contact sports such as basketball, soccer, and football (3). Even outside of the realm of sports, common environmental factors such as slippery or uneven surfaces can increase the risk for injury.  

However, more specifically, strains can be caused very easily by a singular event, such as lifting heavy things incorrectly or long term, by chronic muscle stress (4). Repetitive movements can put excessive stress on a muscle or tendon, causing it to slowly become more and more injured over time. Sports such as tennis or golf can also contribute to strains like this because of their repetitive nature (5). 

Sprains can also be caused by poor equipment and fatigue, which could make you less likely to provide the necessary support for the joint. 

I Am Injured. Now What? 

It can be difficult to differentiate between a sprain and a strain as they tend to produce very similar symptoms (6). However, the good news is that the recommended treatment for immediate care is the same for both sprains and strains.  

Immediate Care: The RICE Method (7) 

• Rest: By avoiding stressing the affected area, swelling will decrease and recovery can begin. 
• Ice: Cooling the area limits injury-related tissue damage, reduces swelling, and can reduce pain. 
• Compression: Using bandages restricts swelling that can occur and prevents hemorrhage. 
• Elevation: By keeping the injured area elevated, excess blood and inflammatory fluids are reduced. 

When to Seek Medical Attention 

There are some cases in which it is important to seek immediate medical attention when injured. If any of these symptoms apply to you, your injury is likely not a sprain or a strain, but rather a broken bone: 

• A crack was heard when the injury took place. 
• The affected area changed shape or is pointing at an odd angle. 
• There is numbness or tingling in the affected area. 
• The skin of the affected area has changed color or is cold to the touch. 

Aside from these instances, it’s typically advised to try the RICE Method first, as most sprains and strains will feel better after two weeks. However, in serious cases, additional medical attention may be required (8). Seek medical attention if after implementing the RICE Method, if the injury: 

• Is very painful or the pain is getting worse, 
• Has large amounts of swelling or bruising beyond normal, or the swelling and bruising is getting worse, 
• Is painful to put weight on, 
• Feels stiff or difficult to move, 
• Is not getting better, 
• Is accompanied by fever or chills, which could indicate an infection. 

Since sprains and strains can be difficult to differentiate, medical professionals are typically more equipped to provide an accurate diagnosis. Healthcare professionals will obtain a detailed clinical history, followed by a physical examination with inspection and palpation, along with function tests (9). For more specific and thorough diagnosis, ultrasound methods are currently the most clinically viable for their assessment of tissue strains due to their non-invasive, low cost nature (10). 

Treatments of Sprains and Strains 

In addition to the RICE Method, early mobilization can promote healing, but only if it is not introduced too soon. Like with any injury, the body needs time to allow scar tissue to form, but after that the increased vascularization of the area encourages regeneration. In terms of pain management, NSAIDs and glucocorticoids may be recommended by healthcare professionals on a need basis.  

As the healing progresses, physical therapy and subsequent isometric, isotonic, and isokinetic exercises can be very helpful in re-training the body to move correctly again. Typically, these courses of action are enough to induce healing and get patients back on track however, sometimes these types of injuries do require further intervention that may look like weight bearing aids, therapeutic ultrasound therapy, and even surgery. However, there has also been some research looking into the effectiveness of massage, cryotherapy, and hyperbaric oxygen exposure.  

NeuroTherapy and Electrostimulation 

Additionally, companies such as ARPwave have seen success with their NeuroTherapy protocols which mix exercises, like those mentioned above with electrostimulation (11). Studies have shown that electrostimulation in ankle sprains had statistically significant levels of edema reduction (12) and generally, electrostimulation has been used in recent years for the overall management of pain (13). ARPwave uses these principles to locate the true source of pain in the body and retrain the muscles in a way that allows the injured area to heal faster than it would without intervention. 

Preventing Sprains and Strains  

While typically not life threatening, strains and sprains can put you out of commission for a couple of weeks or more. Continue maintaining an active lifestyle, free of these set backs with these tips (14): 

• Avoid doing too much too soon. 
• Strengthen the muscles surrounding your joints. 
• Avoid repetitive motions, integrating cross training instead. 
• Never skip a warm up or cool down. 
• Always use proper form and technique. 
• Keep in shape. 
• Use proper equipment. 

Using validated protective equipment and adhering to safety protocols when being active can significantly reduce the risk of injury (15). For example, helmets and mouth guards have been shown to considerably decrease the rate of catastrophic head injuries and dental/oral injuries in athletes (16). 

Additionally, maintaining a high level of fitness puts individuals at a lower risk for injury in the long term. Individuals with high levels of fitness operate at a lower percentage of their max capacity, resulting in their ability to perform a task for longer periods of time, fatigue less rapidly, recover faster, and have a greater energy reserve for subsequent tasks. Strength, muscular endurance, cardiorespiratory endurance, coordination, balance, flexibility, and body composition are all considered valuable components in the pursuit of fitness and each contribute in their own way (17). 

Recovery and Rehabilitation 

Recovery from sprains and strains varies based on both the severity of the strain and the individual’s commitment to adhering to their treatment plan. Rehabilitation exercises are incredibly important for full return of function and should not be taken lightly. The effectiveness of the rehabilitation program is often the determining factor of the success of future function and athletic performance and should be structured and individualized on a case by case basis (18). 

Despite this, there are many studies that have shown that low adherence to rehabilitation programs is a common problem (19) and that providers are more often than not, needing to employ various strategies to improve that behavior (20). So, going into a rehabilitation program with a positive mindset and a determination to stick to it will already put you leagues ahead in your healing journey. 

Lifestyle Adjustments for Joint Health 

The best treatment for any injury is prevention. So, before experiencing any injury, make sure to check out these tips for maintaining joint health. 

• Be active! 
• Maintain a healthy weight. 
• Wear protective equipment. 
• Consult with healthcare providers when necessary. 

When to Consider Surgery 

In the past, surgery for strains and sprains was more commonplace, however research has shown that the long term effects of surgical treatment tend to be similar to the long term effects of functional treatment such as physical therapy. Surgeries can have a higher risk for complications so, in recent years the medical community has steered away from recommending surgery right away. Surgical techniques emphasize invasive repair and reconstruction and should only be considered if traditional methods fail. That said, each case is unique and it’s incredibly important to weight the potential risks and benefits with a healthcare provider before undergoing any type of surgery. 

Conclusion 

Sprains and strains are a common yet complex set of injuries that require a mixture of comprehensive prevention as well as informed treatment. By understanding the injury and how it can occur, you will be better equipped to take preventative measures and manage the recovery process. However, with all injuries, remember to always consult with healthcare professionals if you have any questions.