People use the words “sprain” and “strain” almost interchangeably, to describe everything from a twisted ankle to a pulled hamstring. But they’re not the same.
A sprain is a stretch or tear in a ligament. Ligaments are bands of fibrous tissue that connect bones to bones at joints.
A strain is also a stretch or tear, but it happens in a muscle or a tendon. Tendons link muscles to the bones.
How Do Sprains Happen?
Sprains usually happen when a person falls, twists, or is hit in a way that forces the body out of its normal position.
The most common type of sprain is a sprained ankle. About 25,000 people sprain an ankle every day. Think of a runner who goes over a curb and catches their foot, twisting the ankle; or a baseball player who slides into a base and twists their knee.
Wrist and thumb sprains are also common, particularly in sports like skiing, where it’s not unusual to fall and land on an outstretched palm.
How Do Strains Happen?
Athletes in contact sports, like football, hockey, and boxing, have the biggest chance of strains. Even in noncontact sports like tennis, golf, or rowing, doing the same motions over and over can lead to strains of the hand and forearm.
These injuries can happen when you work out at the gym, or they can happen at home or the workplace, especially if you do a lot of heavy lifting.
How Can You Tell the Difference?
The signs of most sprains or strains are very similar: pain and inflammation, and sometimes bruising, at the injured area. Depending on how bad the sprain or strain is, the pain may be mild, moderate, or severe.
The worse the sprain or strain, the harder it is to use the affected area. Someone with a mild ankle sprain may just favor that ankle slightly. A more severe ankle sprain may cause much more pain and make it tough or impossible to walk.
If you have a sprain, your doctor may mention its “grade”:
- Grade I is stretching of the ligament or a very mild tear, with little or no instability at the joint.
- Grade II is a more serious but still incomplete tear, with some looseness in the joint.
- Grade III is a completely torn or ruptured ligament. This is not a broken bone, but can feel like one since it’s often impossible to put weight on the joint or use the affected limb because the joint isn’t stable.
Most people with mild sprains and strains can treat these injuries at home by following “RICE” therapy (see below). For more severe cases, see a doctor, who may do X-rays to check that you don’t have a fracture. You may also get an MRI to check on your ligaments.
Even if you don’t have a fracture, you may need other treatment, such as an ankle cast and/or crutches for a severe ankle sprain. In some cases, you may need surgery to repair the torn ligament or tendon. Physical therapy and rehabilitation exercises often help, too.
Although the degree of pain and swelling are usually the best indicators of how severe a sprain or strain is, this is not always the case. Some injuries, like Achilles tendon tears, may cause only mild pain at first, but are actually more severe.
See a doctor right away if any of these things happen:
- The pain and swelling don’t start to ease within 24 to 72 hours.
- You cannot bear weight.
- Your symptoms get worse.
The gold standard of care for sprains and strains is known as “RICE” therapy. It stands for:
- Rest: Don’t put weight on the injured area for 24 to 48 hours. This includes not lifting with an affected wrist or elbow. If you physically cannot put weight on an injured knee or ankle, see your doctor.
- Ice: Put a bag of ice on the injured area for 10 minutes at a time, and then take it off for at least 30 minutes over the course of the first 3 days. Wrap the ice in a damp cloth or put it in a plastic bag. (Don’t put ice directly on your skin). The cold constricts blood vessels and slows down the inflammatory process, which eases pain and swelling. But using ice for too long at a time can cause injury, so take breaks.
- Compression: You can either wrap an injured wrist, ankle, knee, or elbow in an elastic bandage, or buy a compression sleeve. Like ice, compression helps to keep the swelling down.
- Elevation: Lie down and place the injured area on a pillow, and raise it above the level of your heart. This will keep fluid from collecting in the area, so you don’t have as much swelling.
RICE therapy is particularly important during the first 24 to 72 hours after a sprain or strain happens. During this time, you can also take medication to curb pain. Check with your doctor to see what medicine is OK for you, and follow the instructions on the label exactly. If you have questions, ask your doctor or pharmacist.
As your pain and swelling gets better, you can cut down on RICE therapy and start to use the affected area again. You’ll need ice and compression less often, such as at the end of the day, as swelling and pain tend to flare up after use.
You probably can’t wait to get active again, but you shouldn’t rush it. You could reinjure the area and make it worse.
On the other hand, you shouldn’t rest the injured area too long, or scar tissue could limit what you can do.
It’s best to rehab your injury gradually. Your doctor or a physical therapist can recommend certain exercises that can help you get back to your normal routine bit by bit, at a safe pace.
For example, if you’ve sprained your ankle, you may begin by walking slowly on a flat treadmill, then move to an incline, then begin to jog. Someone with a sprained wrist may begin with range-of-motion exercises, and then move on to lifting very light weights.
You can expect some discomfort during rehabilitation. But a sudden flare-up of severe pain is a signal to take a step back and move more cautiously. Talk to your doctor if this happens.
The time frame for recovery depends on the severity of the injury and can vary from person to person. It may take just a few days for a slight sprain of an ankle to heal, or it may take months for a knee that needs surgery to reconstruct it.
For most mild to moderate sprains and strains, you can expect to regain full mobility within 3 to 8 weeks. More severe injuries can take months for a full recovery.
Questions to Ask Your Doctor
You should have an understanding before you leave your doctor’s office or hospital about what you need to do to recover. Make sure you have answers to these questions:
- What is my injury?
- What’s OK for me to do? What activities should I avoid?
- What can I safely take for pain and how often?
- How long will my recovery take? What can I expect during that time?
- When is it safe to return to full activity?
- When do I need to get my injury re-evaluated?