Strains and Sprains

If you’re physically active, chances are you’ll suffer a strain or sprain at some point. These common types of muscle and ligament injuries can happen if you fall and land awkwardly, if you collide with something or if you’re moving quickly and suddenly change direction. So naturally you’re particularly susceptible to a strain or sprain if you play sports regularly or you have a job or lifestyle that involves a lot of physical activity.

Both strains and sprains can be painful. The two, however, are not exactly the same thing.

What is a strain?

A strain is damage to a muscle, most commonly a leg muscle or back muscle (for instance the hamstring muscle at the back of the thigh or a muscle in the lumbar region of your back). It’s caused by stretching, pulling or tearing of muscle fibres and is usually the result of the muscle in question being stretched too far (that is, beyond its normal limits) or by being forced to contract too quickly and/or strongly.

You know you have a strain if the muscle in question is painful when you use it and also when it’s resting; if the area looks red, bruised or swollen; if you’re experiencing spasms in that muscle; and if the muscle becomes so weak that it loses some or all of its function.

Strains are graded according to how severe they are:

• First-degree strain: this is when a few muscle fibres are stretched, pulled or torn, resulting in tenderness and pain, but the muscle has normal strength and movement.

• Second-degree strain: this has more injured fibres than a first-degree strain, causing more severe pain, swelling, possible bruising and some loss of strength.

• Third-degree strain: this is a complete tear of the muscle resulting in total loss of function of the muscle.

Strains can also be acute – that is, caused by a sudden injury or trauma – or chronic (such as when caused by prolonged, repetitive movements as with repetitive strain injury).

What is a sprain?

Sprains are injuries to a ligament (this explains why they’re also called torn ligaments). Like strains, these are also common, with around 30 - 50 per cent of musculoskeletal injuries seen by healthcare providers being ligament and tendon injuries (i).

Ligaments are bands of supportive connective tissues around joints that connect your bones together. When they are overstretched suddenly, they can become damaged, causing pain, inflammation, swelling, bruising and joint function problems. Ligaments in the knee and at the side of the ankle are the most commonly affected (for example, the knee’s anterior cruciate ligament – or ACL – is often injured during sporting activities). Find out more about what a sports injury is here.

Like strains, sprains are classified according to their severity:

• Grade I: this describes mild stretching of the ligament without joint instability.

• Grade II: this is a partial tear of the ligament leading to no or mild joint instability.

• Grade III: this is a complete rupture of the ligament leading to joint instability.

How long do they last?

How long you’ll need to recover from a strain or sprain will depend on how badly you’ve injured yourself – most usually heal within a few weeks. You should be able to walk within a week or two of having a mild ankle sprain, for example, though you may find it takes longer – sometimes months or even years – before your ankle is fully recovered.

You should, however, avoid strenuous exercise such as running for up to eight weeks because there’s a risk of further damage, advises the NHS (ii).

Self-help for strains and sprains

Strains and sprains may be painful, but the good news is you should be able to treat most minor cases yourself at home.

The first thing you should do after sustaining an injury is use the PRICER principle – that is, protect, rest, ice, compression, elevation and rehabilitation:

Fingers and shoulders are the most commonly dislocated joints, while dislocations of other joints such as elbows, knees and hips are less common.

Protect

Use something to protect the injured area where possible, such as a sports support or shoes that enclose and support your feet (lace-up ankle boots, for example).

Rest

For the first 48 - 72 hours after an injury you should rest the affected area as much as possible and avoid any type of activity that puts pressure on it and causes more pain.

Ice

Apply ice to the affected area during the first 48 hours, as soon as possible after the injury. Place an ice pack on the affected area for around 20 minutes every three or four hours. If you don’t have an ice pack in your freezer you can make your own by wrapping some ice cubes or a bag of frozen peas in a towel (never apply ice or anything frozen directly on your skin as they can cause ice burns). This may help reduce pain and limit inflammation and bruising, as the cold is thought to reduce blood flow to the area.

Compression

Apply a compression bandage to the affected area. Try an elastic bandage or a tubular compression bandage (both are available without a prescription at pharmacies). Don’t wrap the area too tightly – the bandage needs to be tight enough to apply mild pressure but it shouldn’t be uncomfortable (if it’s too tight, it could interfere with your blood flow). Take the bandage or support off when you go to bed.

Elevation

If possible, raise the affected area above the level of your heart for as long as you can during the first 48 hours. If you’ve sprained your ankle, try to keep your foot on a stool that’s level with your hip or higher when you’re sitting, and put some pillows under your feet when you’re in bed.

Rehabilitation

This is also known as therapeutic exercise and is designed to get you back to fitness gradually and safety – though it usually only applies to sportspeople and athletes. It usually involves following an active rehabilitation programme tailored for the individual by a physiotherapist.

At the same time, avoid HARM (heat, alcohol, running and massage) for 48 - 72 hours after sustaining your injury:

Heat

Avoid anything that encourages blood flow, including hot baths, saunas and heat packs. However, after 72 hours, when there should be no further bleeding or inflammation, it may be a good idea to use heat, as it can be soothing on a strain or sprain.

Alcohol

Stick to non-alcohol drinks (like heat, alcohol can increase blood flow, which may make bruising and inflammation worse after an injury).

Running

Avoid any type of exercise that could make your injury worse (running is just one example).

Massage

This too may increase bleeding and swelling, as it can increase blood flow to the area. But like heat, massage can be soothing if it’s used after 72 hours.

Over-the-counter remedies for strains and sprains

There are several over-the-counter products available that may help reduce the pain and inflammation caused by a strain or sprain.

You can buy sprays and patches that contain cooling agents to help straight after an injury, plus heat sprays, pads, creams and gels that can provide relief later (only use heat 72 hours or more after an injury).

If you’re in more pain than you can tolerate, over-the-counter painkillers can be useful. Two 500mg paracetamol tablets, for instance, can be taken up to four times a day for pain relief, or you may need a stronger over-the-counter preparation called co-codamol if paracetamol alone doesn’t provide enough relief. Co-codamol contains codeine and should only be used in the short term - according to the NHS unless your doctor has prescribed co-codamol for you, you shouldn’t use it for more than three days (iii).

Three days after your injury you may want to take an anti-inflammatory tablet such as ibuprofen, which is available without prescription (don’t take these types of medicines any sooner after sustaining an injury as they may interfere with healing (iv)).

Ibuprofen and other anti-inflammatory painkillers aren’t suitable for everyone – if you have asthma, high blood pressure, chronic kidney disease or heart failure, you’ll usually be advised not to take them. If in doubt, check with your GP or pharmacist to make sure anti-inflammatories are suitable for you.

Alternatively, you may want to use an anti-inflammatory gel that contains ibuprofen or another anti-inflammatory drug called diclofenac. The gel should be applied directly to the affected area, but not if the skin is broken or damaged in any way (wash your hands thoroughly after use). Again, anti-inflammatory gels aren’t suitable for everyone, so check before you use them.

Professional help

You shouldn’t usually need to see your GP for a minor strain or sprain. However, if the pain or swelling gets worse or fails to improve, or you find it difficult to move the affected area after treating your strain or sprain yourself – if you find it difficult to walk, for instance – it’s a good idea to get help from a medical professional.

You should also see your GP if you experience any of the following:

• Pain or bruising.

• Tenderness over a bone.

• A joint that doesn’t function properly or feels week after the initial swelling and pain has subsided.

• A joint that looks deformed rather than just swollen.

• Numbness or a cold feeling in the affected area (particularly the foot).

• A suspected fracture.

Preventing strains and sprains

Strains and sprains may not always be preventable, but there are a few things you can do to make injuring yourself less likely:

Prepare for exercise

It’s important to warm up properly before playing sports or taking part in other physical activities – try walking or jogging on the spot for a few minutes, then doing some knee bends, knee lifts and shoulder lifts to prepare your muscles. Also do some simple stretches to cool down when you finish – if you’re not sure how to stretch, take a look at this easy guide from the NHS.

Regular stretching and strengthening exercises can also help reduce the risk of sprains and strains by helping your joints and muscles stay strong and supple. Meanwhile, avoid exercising or playing sports when you’re tired, and try not to run on uneven surfaces whenever possible.

Wear the right shoes

Always wear the correct shoes for different activities and sports to protect your feet and ankles against injury. If you’re walking or hiking, for instance, choose boots that support your feet and your ankles to avoid any sprains rather than shoes.

Good running shoes are a must if you run or jog. Consider buying a pair from a specialist running shop, where you can have your gait (or running style) analysed. Different shoes are suitable for different gaits, including shoes for people whose feet roll inwards too much (overpronation) and for those whose feet don’t roll inwards enough (underpronation or supination).

Wrap it up

If you’re recovering from a previous injury, taping, strapping or wrapping your knees, elbows or ankles may be useful when you first start getting back into regular exercise. However, only use wraps as a short-term protective measure.

Guard against falls

According to the Royal Society for the Prevention of Accidents, more accidents – of which falls are the most common – happen at home than anywhere else. Make your home and garden safer by clearing away clutter from stairs, walkways and driveways and by wearing well-fitting shoes rather than loose or badly worn footwear that could make you trip. Also check your carpets and rugs for signs of wear and watch out for any uneven surfaces and slippery paths and floors. During the winter, keep a stock of sand or salt to make any icy areas around your home safer to walk on.

 

Natural remedies for strains and sprains

No matter how much you do to try and prevent a strain or sprain, the fact is that accidents can – and do – happen. So as well as using the self-help measures of PRICER and HEAT, here are some nutritional supplements you could try that may help you recover:

Tackle inflammation

Natural supplements that help reduce the inflammation that causes swelling may be useful in relieving pain and speeding up the recovery process.

For instance, natural health practitioners often recommend turmeric – which contains the active ingredient curcumin – for conditions where there is inflammation. One study also claims extracts of a plant family that turmeric belongs to – namely the Zingiberacae family – are effective painkillers but without the side effects associated with non-steroidal anti-inflammatory drugs (NSAIDs) and other conventional painkillers (vi). Evidence elsewhere suggests curcumin may speed up wound healing by reducing the body’s natural response to wounds such as inflammation (vii).

Meanwhile, the omega-3 essential fatty acids found in fish oil supplements have also been shown to help reduce inflammation (viii). Indeed, one study suggests fish oil supplements are also a safer alternative to NSAIDs for the treatment of neck or back pain (ix). Note: to get the most out of fish oil supplements, aim to take a high-strength product with good levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Meanwhile if you’re a vegetarian or vegan you can still benefit from an omega-3 supplement, thanks to the availability of products that contain the natural triglyceride (TG) form of omega-3. This is sourced from plant organisms called microalgae rather than fish oils.

Some experts also believe bromelain may have an anti-inflammatory effect on the body (x). Made up of a group of protein-digesting enzymes found in pineapple juice and in the stem of pineapple plants, bromelain is often used as a treatment for sports injuries, with one informal study suggesting it may help bruises to heal more quickly (xi).

Strengthen joints

A key building block for making cartilage, glucosamine is produced naturally in the body. It is often recommended by natural health practitioners as a treatment for osteoarthritis. Some athletes also take glucosamine supplements to prevent strains and sprains, with one study hinting that it may aid recovery from sports injuries to the knee (xii).

Repair connective tissue

Vitamin C may help with the healing of connective tissue as it helps the body produce collagen, a basic component of connective tissue. Indeed, there is some evidence that vitamin C deficiency may delay healing from injury (xiii), and that severe injuries boost the body’s need for vitamin C (xiv). Experts also believe that taking vitamin C could reduce pain and help with muscle recovery after intense exercise (xv).

Nutritional substances called anthocyanidins – which belong to a group of plant chemicals called flavonoids – are thought to increase the amount of vitamin C in your body as well as strengthen collagen. Pigments found in the skin of dark and richly coloured fruit, anthocyanidins can be sourced from blueberries, blackberries, raspberries and red grapes. You can also boost your anthocyanidins intake with a nutritional supplement.

Keep yourself protected from strains and sprains by following our simple advice laid out above. If you do happen to get hurt, don’t worry, most strains and sprains heal after a couple of weeks of rest. Find out more about common health problems in our health library.

 

References:

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12. Ostojic. SM, Arsic. M, Prodanovic. S, et al. Glucosamine administration in athletes: effects on recovery of acute knee injury. Res Sports Med. 2007;15:113-124.

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15. Levine. M. New concepts in the biology and biochemistry of ascorbic acid. N Engl J Med 1986;314:892-902.

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    Kaminski. M, Boal. R. An effect of ascorbic acid on delayed-onset muscle soreness. Pain. 1992;50:317-21.

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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