Sprain or Strain: It’s Not the Same

We have all heard someone say, “I’ve sprained my ankle!” or “My doctor says it is just a back strain.” Often times, people think that the terms sprain and strain can be used synonymously, but they are quite different both in terms of their definition and the plan of care for the injury.

A strain is defined as an injury to a muscle or its tendon. A tendon is thickened tissue that connects the muscle to the bone. Strains usually occur as a consequence of overstretching or excessively contracting a muscle during some activity. Pain and weakness are usually immediately evident after a strain. Muscle spasms or guarding usually become evident if a strain is untreated.

A sprain is an injury that affects ligaments. Ligaments connect ‘bone to bone’ and provide stability to our joints. The severity of the injury can range from a minor stretch to a complete tear of the ligament. These injuries are usually evident after significant trauma, such as a car accident or fall. Sprains are frequently experienced in sporting events, usually caused by an accidental hit or some other force resulting in a joint being taken beyond its normal position or range of motion. Immediate swelling, visible bruising, and instability of the underlying joint are usually evident. Movement of the joint is also usually painful.

From a physical therapy standpoint, proper diagnosis of either type of injury is important in order to allow early and proper treatment, to prevent long-term joint dysfunction, and to avoid potential further injury or substitution of other muscle groups. The most important difference between the sprain and strain injury is the types of tissue involved. In terms of the strain, muscle tissue can repair itself and return to its normal strength and flexibility. Treatment usually involves management of the swelling and pain, followed by exercises to increase flexibility and strength of the injured muscle. If a ligament is stretched or damaged, the rehabilitation plan is completely different because ligamentous tissue lacks the elasticity of muscle and usually does not return to its pre-injury state. Initial care instead focuses on protection of the joint and injured ligament, and management of the pain and swelling. Exercises emphasizing range of motion and stabilization of the joint are then initiated to allow the muscles that surround the joint to provide the stability that was previously provided by the now-injured ligament. In the case of a complete tear of a ligament or tendon, referral to an orthopedic surgeon is recommended to determine the necessity for surgical repair. The good news is that a majority of strain and sprain injuries are successfully managed with physical therapy, but as previously stated, early diagnosis and intervention is important.

Please note the information provided in this column is for educational purposes only and should not be substituted for a proper physical therapy or orthopedic evaluation and treatment. •

Mr. Schafer received his Master of Science degree in Physical Therapy from the University of Miami (Florida) School of Medicine. Mr. Schafer is a Licensed Physical Therapist and has practiced in the area of outpatient orthopedic and sports physical therapy since 1997. Mr. Schafer may be reached at 412-257-0314. His clinic’s website is www.schaferpt.com. Schafer Physical Therapy, PC is located at 3249 Washington Pike, Suite 1102, in the Portman Commons Plaza.