The Difference Between a Sprain and a Strain
Many patients with musculoskeletal injuries get confused about the difference between a strain and sprain. Your physical therapist can show you the difference between what a sprain and a strain is and how to properly treat each of these distinct injuries.
Strains are injuries that affect muscles or tendons, the thick bands that attach muscles to bones. They occur in response to a quick tear, twist, or pull of the muscle. Strains are an acute type of injury that results from overstretching or over contraction. Pain, weakness, and muscle spasms are common symptoms experienced after a strain occurs.
Sprains are injuries that affect ligaments, thick bands of cartilage that attach bone to bone. They occur in response to a stretch or tear of a ligament. Sprains are an acute type of injury that results from trauma such as a fall or outside force that displaces the surrounding joint from its normal alignment. Sprains can range from a mild ligamentous stretch to a complete tear. Bruising, swelling, instability, and painful movement are common symptoms experienced after a sprain occurs.
Muscle strains are caused by high-velocity forces acting against a muscle. A sudden motion may cause your muscle to quickly overstretch and then contract forcefully, leading to mild or severe tearing of the muscle tissue. Sometimes, but not always, bruising may be present if you strain a muscle.
How can you tell if you have strained a muscle? Typically, the muscle you strain will hurt when you try to contract it. For example, if you strain your hamstring, you will likely feel pain when you try to use the hamstring muscle to bend your knee.
Overstretching a muscle that has suffered an acute strain may also cause pain. Stretching your hamstrings in the days following a hamstring muscle strain will likely be painful, indicating that your muscle is strained.
Ligament sprains are caused by a forceful movement to your body that places stress on a ligament. If you twist your ankle, for example, the ligaments on the outer part of your ankle joint may become overstretched. They might even tear. This overstretching or tearing is a ligament sprain.
Strain and Sprain Severity Grades
There are different grades of muscle strains, ranging from grade I to grade III.
- Grade I muscle strains indicate that the muscle tissue is simply overstretched.
- Grade II muscle strains occur when the muscle tissue is partially torn.
- Grade III strains are full-thickness tears through the muscle tissue. These typically are considered severe and are accompanied by significant pain, swelling, bruising, and functional mobility loss.
If your doctor or PT determines that you have a muscle strain, he or she may consider obtaining diagnostic images like an MRI to determine the full nature of the injury.
Ligament sprains grading follows along similarly to muscle strain grades.
- Grade I: the ligament is simply overstretched
- Grade II: the ligament is partially torn
- Grade III: the ligament is completely torn
Ligaments sprains are typically accompanied by excessive motion around the joint that is supported by the ligament. Significant swelling and bruising may also be present.
When to See a Doctor
If you suffer an injury like a sprain or strain, how do you know when you need to see your doctor. Generally speaking, a visit to a doctor after any trauma is a good idea; there may be hidden problems that you simply cannot diagnose without the aid of a medical professional.
You should absolutely see your doctor if:
- Your injury is accompanied by significant swelling
- There is significant bruising
- Your pain is extreme
- Your ability to move the affected joint is severely limited
- Your symptoms fail to improve after a few days of rest
Bottom line: if your pain and symptoms limit your ability to comfortably move around after your injury, check in with your doctor.
Diagnosing Sprains and Strains
Muscle strains are usually diagnosed by your doctor or physical therapist. Two characteristics of muscle stains found during an examination include:
- The muscle hurts when you contract it
- The muscle hurts when you stretch it
Examination of your injury may also reveal tenderness to palpation, bruising, and swelling. Your doctor may also perform diagnostic imaging tests including an x-ray, which will show the bones near your injury, or an MRI to look at soft tissue near your injury. The MRI will likely show a muscle strain and can reveal the severity of your injury.
Diagnosis of a ligament sprain includes various clinical tests performed by your doctor. He or she will likely palpate your joint and ligament, feeling for warmth and swelling, which are signs of inflammation. Tests of the range of motion and strength around your injured joint will be performed.
Many special tests, like the anterior drawer test for the ACL in your knee or the drawer test in your ankle, rely on pulling on your joint to test if excessive mobility is present. These give your doctor clues that a ligament sprain may be present. An MRI is typically necessary to determine if a sprain is a grade I, II, or III.
Muscle Strain Treatment
Initial treatment for a muscle strain is rest. You must let the tissues heal, and that takes time to build the collagen bridges and scar tissue that will one day become healthy muscle tissue. Depending on the severity of the strain, your rest period may be from one week to four or six weeks. During this time, ice may be applied to help ease the pain and swelling.
Once some healing has taken place, you may benefit from PT exercises to start to gently stretch the injured muscle tissue. This helps it become healthy, pliable tissue again. Your PT can show you the best stretches for your specific condition.
Strengthening exercises may also be performed to start to rebuild muscle tissue near the strain area. Exercises should be started gently and gradually progressed. Your goal is to improve the force-generating capacity of your injured muscle so you can return to your previous level of function.
Muscle strains typically heal completely in about six to eight weeks. Severe strains may take longer, and minor strains may be healed in just a few weeks. Again, follow the advice of your doctor or physical therapist to be sure you do the right treatment for your muscle strain.
Ligament Sprain Treatment
If you have a ligament sprain, you may benefit from physical therapy to help you fully recover. Your physical therapist will use various techniques to improve your pain, swelling, and overall range of motion and strength around the area where your ligament is sprained.
Initial treatment for a sprain includes following the R.I.C.E. principle. Rest the affected joint, and place ice on it with compression and elevation. (Some PTs recommend following the P.O.L.I.C.E. principle of protection, optimal loading, ice, compression, and elevation.)
Gentle range of motion exercises are usually started a few days after a sprain injury. Slowly moving your affected joint passively and actively can help keep things moving while they are healing. You may be required to wear a brace during the initial phases of healing for a ligament sprain.
Performing strengthening exercises to help support the joint where the ligament is injured may be necessary. For severe grade III sprains, surgery may be necessary to stabilize your injury and to allow you to get back to normal activity.
Typically, recovery from both muscle strains and ligament sprains takes about four to eight weeks. Your exact healing time may vary based on the severity of your injury.
Prevention Of Sprains and Strains
Many patients as if there is a way to prevent muscle strains and ligaments sprains from happening. There may be. Research indicates that performing eccentric exercises, like the Nordic Hamstring Curl or the Alfredson Protocol for the Achilles tendon, may have a protective effect for muscles and tendons. Eccentric exercise occurs when your muscle is contracting while it is lengthening. The mechanism of action for this protective effect is not yet fully understood.
You may be able to prevent ligament sprains through neuromuscular training with your physical therapist. Your PT can teach you to jump and land properly which can keep your body in an optimal position to prevent sprains. Improving lower extremity proprioception has also been shown to prevent ankle sprains.
If you are having pain or limited mobility after an injury, you should visit your doctor and physical therapist to determine if a sprain or strain may be the cause of your condition. Understanding the difference between a sprain and a strain can ensure that you have the correct diagnosis for your condition. This can help guide the correct treatment. Working closely with your PT can help you return to your previous level of activity.
- Schiftan, GS, etal. The Effectiveness of Proprioceptive Training in Preventing Ankle Sprains in Sporting Populations: A Systematic Review and Meta-Analysis. Journal of Science in Medicine and Sport. 18(3): May, 2015.
- Stevens M, Tan C-W. Effectiveness of the Alfredson Protocol Compared With a Lower Repetition-Volume Protocol for Midportion Achilles Tendinopathy: A Randomized Controlled Trial. Journal of Orthopaedic & Sports Physical Therapy. 2014;44(2):59-67. doi:10.2519/jospt.2014.4720.