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Muscle Sprains and Strains

Muscle sprains and strains facts

A sprain is abnormal stretching or tearing of a ligament that supports ajoint.

A strain is abnormal stretching or tearing of a muscle or tendon. Sprains and strains may be caused by repetitive activities or by a single

event.

The diagnosis of a sprain or strain usually can be made after thehealthcare professional takes a history of the injury and performs a

physical examination. Depending upon the situation, X-rays, CAT scan, or

MRI scan may be needed to help make or confirm the diagnosis.

RICE (rest, ice, compression, and elevation) are the keys to treatment. Most sprains and strains resolve with time, but occasionally other

treatment, including physical therapy and surgery, may be required. Anti-inflammatory medications may be helpful in decreasing the pain and

inflammation of the injury.

What is the difference between a sprain and a strain?

A sprain is an injury to ligaments, while a strain is an injury to muscle or tendon tissue.

How muscles work

The purpose of muscles is to allow the body to move. A muscle attaches to bone, either directly or by

way of a tendon, on each side of a joint. When the muscle contracts, the joint moves through its rangeof motion. The muscle that you feel underneath your skin is really made up of many smaller bundles of

muscle fibers called fascicles. These, in turn, are made up of individual muscle fibers that are

crosslinked to allow them to slide back and forth within the fascicle. Sliding together causes the muscle

fibers to shorten and the muscle to contract and move the joint. The fibers return to their resting

position when the fibers elongate and allow the joint to relax.

The transition of muscle to tendon happens gradually as muscle fibers give way to tendon fibers before

the bony attachment occurs. The anatomy of each tendon is different and depending upon their location

in the body, the tendon portion may be very short or very long. A strain is damage caused by an

overstretched muscle or tendon, causing their fibers to be pulled apart and lose the ability to contract.

The severity of injury depends upon the amount of tissue that is damaged. The muscle fiber may be juststretched, partially torn, or completely torn apart. The most common cause of the injury is overuse,

which weakens the muscle. Muscles and joints are forced to perform movements for which they are not

prepared or designed. An injury can occur from a single stressful incident, or it may gradually arise

after many repetitions of a motion. The damage can occur in three areas: the muscle itself, the muscle

tendon intersection where the muscle fibers transition to tendon fibers, or the tendon itself. Strains are

described by the severity of damage in three grades:

Grade 1 strains usually cause stretching of a few of the muscle fibers. Grade 2 injury is more significant damage and some muscle fibers are

damaged and torn.

Grade 3 injury is a complete rupture of the muscle.

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How joints work

Joints are stabilized by thick bands of tissue called ligaments that allow the joint to move only in

specific directions. Some joints move in multiple planes. Therefore, they need more than one group ofligaments to hold the joint in proper alignment. The ligaments are anchored to bone on each side of the

joint. If a ligament is stretched or torn, the injury is called a sprain.

The grading system for sprain injury is similar to that of strains.

Grade 1 sprains describe fibers of the ligament that are stretched. Grade 2 sprains are injuries where part of the ligament is torn. Grade 3 sprains are when the ligament is completely torn or ruptured.

What causes a sprain or strain?

Sprains and strains occur when the body is put under physical stress. In these situations, muscles andjoints are forced to perform movements for which they are not prepared or designed. An injury can

occur from a single stressful incident, or it may gradually arise after many repetitions of a motion.Usually, the mechanism of injury involves placing the muscle tendon unit or the ligament under

excessive stretching, causing damage to the muscle, tendon, or ligament fibers.

Where do sprains and strains usually occur?

The ankle is one of the most common joints that is sprained. Usually, the mechanism of injury is a

rapid "rolling" or "twisting" of the ankle and turning it inward so that the sole of the foot starts to point

upward (supination). This causes stretching and damage to the ligaments on the outside or lateral part

of the ankle that hold the joint stable.

Knee sprains are common football injuries and often make headlines because of their potential for

ending professional athletes' playing careers. There are four ligaments of the knee that allow it to act asa hinge joint, flexing (bending) or extending (straightening). The medial and lateral collateral ligaments

and the anterior and posterior cruciate ligaments keep the knee in alignment and are assisted by the

quadriceps and hamstring muscles. As an example of characterization of an injury, when a player

completely tears the anterior cruciate ligament (ACL) in the knee, it is described as a grade 3 injury of

that cruciate ligament.

Neck injuries are common, for example, after a car accident. Whilewhiplashis a nonmedical term, it

accurately describes the head and neck movement when violently flexed forward and backward as the

car abruptly stops. While the rest of the body is held in place with a seat belt and/or air bag, the head is

like a bobble head and can continue moving. Both muscles and ligaments hold the neck bones (cervical

vertebrae) in place and the stresses placed on those structures can cause pain and damage. Sometimes,

the vertebrae are not damaged but the ligaments that support and stabilize the bones are torn, causingsignificant pain and swelling. On occasion, these injuries can cause the neck to become unstable and

put the spinal cord at risk for injury.

Wrist injuries are common because we use our hands to perform many tasks. Usually, the wrist is

damaged because of a fall, but repetitive tasks and a single aggressive move can cause pain. Some

sports are more prone to wrist injuries because of the forces that are asked to be placed on the joint.

These include throwing sports like baseball and football, bowling, skateboarding, snowboarding, and

tennis.

The thumb and fingers can also be injured. Skier's or gamekeeper's thumb describes a sprain at the base

of the thumb where a ligament attached to hold the thumb stable when grasping. It is most often injured

in a fall where the thumb is forced away from the palm of the hand, like when a skier falls and the ski

pole pushes the thumb in an awkward direction.

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Muscles strains may involve any body area that is required to perform work.Lower back painand

spasmis a common result of repetitive lifting injuries, but it only takes one twist or turn at the wrong

time or in the wrong position to cause muscle fibers in the back to tear and go into spasm. Low backstrain is the most common work-related injury.

Muscles of the legs can be damaged from overuse or imbalance. For example, the quadriceps muscle in

the front of the thigh extends the knee and is balanced by the hamstring muscles of the back of thethigh, which flex the knee. Excess bending or straightening can cause the muscle fibers to tear.Muscles that move and stabilize the hip are prone to injury. Groin injuries or groin pulls are strains of

the hip muscles that normally the thigh inward (medically termed adduction). When the leg is pulled

away from the body like doing the splits, the adductors are stretched and potentially damaged.

We use our arms and hands for a variety of activities and the arm muscles (biceps and triceps muscles)

and the forearm can be strained because of lifting, pushing, pulling grabbing, twisting, and any other

activity that you can imagine the arm and hand trying to accomplish.

Chest wall muscles can be pulled because of activities as aggressive asliftingor as seemingly harmless

as sneezing orcoughing. Strains of the large muscles on the outside of the chest (pectoralis muscles) or

the muscles between the ribs (intercostal muscles) can cause significant pain and can mimic the pain ofa broken rib.

The core muscles of the torso of the body, including the abdominal wall muscles and those of the back,

lend stability to the trunk and are often the source of power for the arms and legs to lift and push. These

muscles can be strained from many different activities that require the torso to bend, stretch, or twist.

What are sprain symptoms and signs?

The first symptom of a sprain or strain injury is usually pain, though there may be a delay in onset ofthe symptom and the person who is injured may not recall the specific event that caused the injury. For

example, a person who paints a room may developshoulder painthe day after the repetitive effort of

brushing overhead. This is because inflammation, swelling, and spasm can take time (from minutes tohours) to develop.

Pain is always a symptom that indicates that there is something wrong with the body. It is the message

to the brain that warns that a muscle or joint should be protected from further harm. In work,exercise,

or sport, the pain may come on after a specific incident, or it may gradually progress after many

repetitions of a motion.

Swelling almost always occurs with injury, but it may take from minutes to hours to be noticed.

Anytime fibers of a ligament, muscle, or tendon are damaged, some bleeding occurs. The bleeding

(such as bruising on the surface of the skin) may take time to be noticed.

Because of pain and swelling, the body starts to favor the injured part. This may cause the muscles that

surround the injured area to go into spasm. Hard knots of muscle might be felt near the site of the

injury.

The combination of pain, swelling, and spasm causes the body to further protect the injured part, which

results in difficulty with use.Limpingis an example of the body trying to protect an injured leg.

How are sprains and strains diagnosed?

The diagnosis of a muscle strain or joint sprain is usually made by history and physical examination.The health care professional may want to know the circumstances of the injury and whether the body

sustained damage other than the sprain or strain that brings the patient to seek care. For example, if a

person injured was involved in a significant fall or car accident, the strain or sprain may not be a

priority in caring for the patient with a potentialinternal bleedingorhead injury.

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Physical examination may focus on the part of the body that is injured: the tender muscle or the

swollen joint. It is important to know whether or not there are broken bones or other associated injuries

with the sprain or strain and the health care professional may evaluate the pulses and sensation beyondthe injury site to be certain that there is no associated nerve or artery damage.

X-ray tests may be used to detect broken bones.CTorMRIare not only able to evaluate bone but can

also help evaluate muscles, tendons, ligaments, cartilage, and other structures. Usually, physicalexamination is adequate to make the diagnosis but if surgery is suggested, imaging might be consideredto help plan the operation. Most often CT and MRI tests are performed electively and scheduled to be

done at a future time.

Sometimes X-rays are not recommended. For example, patients with low back pain who have not had a

significant fall, car accident, or injuries and there is little concern that a broken bone exists, do not

particularly require X-rays sincefractureis unlikely. The health care professional may wish to

minimize the exposure to radiation by avoiding these. For ankle and knee sprains, guidelines exist to

help decide when X-rays of those joints might be helpful in finding an accompanying fracture. Usually,

though, physical examination is enough to make rule out any bony injury.

How are sprains and strains treated?

When a muscle, tendon, or ligament fibers are damaged, the body will heal the area by producing scar

tissue. The area that is injured needs to be kept relatively rested while healing.

First aidbegins with rest, ice, compression, and elevation (RICE) and are keys elements in the

treatment of both sprains and strains. More intense treatment can be required depending upon the injury

and the patient's level of function. For example, an athlete who sprains the ACL of their knee may need

to reconstruct the ligament, but an elderly patient who is less active may not need such an aggressive

approach.

Depending upon the extent and location of the injury, it may take many weeks to return to normal

function. That does not mean that all activity must stop; instead, there needs to be a gradual return tofunction that is guided by the body's response to activity. Most often, the patient can "listen" to their

body's response to activity and increase or decrease the amount and intensity of activity. There is a

balance between resting a part of the body enough to help with healing and resting it too much so that

strength and range of motion are lost. For example, when the rotator cuff is strained, it may take a

significant amount of time for the shoulder to return to full function. Resting the arm for a prolonged

period of time in a sling to rest the muscle group may lead to stiffness in the shoulder joint and loss of

range of motion. The health care professional and patient must appreciate that balance and minimize

the loss of function while maximizing the rate of healing.

Muscle, tendon, and ligament heal themselves naturally by repairing the fibers or filling in the

damaged area with scar tissue. Full muscle and joint mobility may take time to return and gradual

stretching may be required to return the injured area to normal. Additionally, depending upon the area

of the body that is injured, the damage sustained, and the amount of loss of function, physical therapymay be suggested. A variety of treatment modalities may be considered, includingultrasoundand

massage, to encourage healing and preserve range of motion and function.

If the muscle or tendon is ruptured or severely torn (grade 3 strain), surgery may be required to repair

the damage. Some common sites of this injury include the

quadriceps (front of the thigh) muscle or its tendon, either the quadricepsor patellar, that allows the knee to extend or straighten tendon;

hamstring muscle located in the back of the thigh and flexes the knee; Achilles tendon which attached the calf muscle to the calcaneus (heel) and

allows the ankle to flex; biceps muscle or tendon, which flexes the elbow.

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Surgery is a consideration for certain sprains. The decision to offer surgical operations to repair

muscle, tendons, or ligaments depends upon the patient's underlying function before the injury and

their expectations for activity after recovery. Not all ligaments need repair, even if completely torn. Forexample, a professional athlete may continue to perform at a high level even with a torn posterior

cruciate ligament in the knee but cannot with a torn anterior cruciate ligament.

Anti-inflammatory medications likeibuprofen(Advil) andnaproxen(Aleve) are often suggested tohelp decrease inflammation and relieve pain. Before taking anyover-the-countermedication, it isimportant to appreciate that side effects and medication interactions exist and it is wise to ask your

health care professional or pharmacist for advice and direction.

For more significant pain, prescription pain medications may be prescribed for a short period of time.

What is the recovery time for sprains and strains?

The goal of treatment is the return the patient to their level of function before the injury. The duration

of recovery depends upon the extent of injury and what part of the body is damaged. The most

important therapy for all injuries is allowing time to recover and heal. Rehabilitating an injury may

involve a home exercise program or it may be a formal physical therapy program. Regardless, it takestime and effort to repair the body and the patient should have a clear understanding of what is expected

to rehabilitate the injury. Some questions that may be helpful include the following:

Are there work or activity restrictions or limitations that need to beobserved?

When can I expect to be able to return to normal daily activities? When can I expect to be fully recovered? Do I need to be re-evaluated, and if so, when?

While it may take weeks for a sprain or strain to be completely healed, the time to return to activity

may be much shorter. Many minor muscle strains resolve themselves in a few days. While the injuredperson can return to full activity relatively quickly, the muscle may not be completely healed and is

less able to withstand excessive stress and may still be more prone to future injury. Similarly, sprained

joints may be functional in a couple of weeks but might take months to heal completely and return to

full strength and stability.

Special situations

Some muscle strains take longer to heal than others due to their location and function.

Chest wall muscle strains

The muscles that help us to breathe operate much like a bellows. The chest wall expands to suck airinto the lungs. When injuries occur to the muscles of the chest wall, healing may be measured in weeks

because the muscles are unable to rest since they are involved in taking in a breath. When there is a

chest wall injury, the pectoralis muscles that cover the front part of the chest and help the arms with

lifting, the intercostal muscles that are located between the ribs and the upper back muscles can all go

into spasm. Regardless of whether there is a broken or bruised rib or a strained muscle, attempts to takea deep breath are met with pain as the muscle is stretched. While an injured arm can be rested in a sling

or crutches can be used to rest an injured leg, it is difficult to stop breathing. It means that 12 -14 times

a minute, the injured muscle is required to work and stretch. Each breath is painful and delays healing.

Chest wall muscles strains may take weeks to heal.

Neck strains

Numerous muscles are required to keep the head optimally stable on the shoulders and to allow it toswivel in many directions. Injuries are common to the trapezius and sternomastoid muscles, large

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muscles that do the major the work of neck turning. Smaller muscles that attach to the bony

prominences of the neck can also be strained. Depending upon the injury, significant pain and spasm

can occur that is long-lasting. Whiplash is a nonmedical term that describes strains and sprains of theneck that occur from violent flexion-extension injuries. Many structures can be the source of pain, and

treatment results depend upon which structure, from muscle to tendon to ligament to nerve, is involved.

What is the prognosis of sprains and strains?

The goal for treating a strain or sprain is to return the patient to their normal level of physical activity.Whether that can be accomplished and the time frame for recovery depends upon the specific injury.

An arm muscle strain may get better with RICE in one to two days and a sprained ankle may take two

to four weeks. However, a torn knee ACL, which is really a grade 3 sprain, may need surgery and a

tear of physical therapy and rehabilitation.

It is important to discuss with your health care professional or therapist, their expectations as to how

long they think your specific injury will take to get better.

REFERENCE:

McPhee, S.J., M. Papdakis, and M.W. Rabow. Current Medical Diagnosis and

Treatment, 50th ed. New York: McGraw Hill Medical, 2011.

REVIEW:

William C. Shiel Jr., MD, FACP, FACR on 8/24/2012

SOURCE:

http://www.onhealth.com