Strains vs. Sprains

Jeffrey Heit Health Guide
  • If you hang around a gym or any type of venue where sports, exercise or physical training take place, or even if you're just a sports enthusiast excited about the start of football season or the baseball post-season, it's not uncommon to hear that someone "strained or sprained" something. "Wide receiver X will be out for at least four games with a sprained knee ligament." "Outfielder Y will be on the 15 day disabled list with a strained hamstring."  It often means sitting on the sidelines or lightening up on your workout routine for a while. But what are sprains and strains? Are they the same thing? Are they serious? And what can I do to treat and/or avoid them?

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    In order to understand what they are, we need a little primer on muscles, tendons, and ligaments. Simply put, humans are able to move because we have bones throughout our bodies. These bones are attached to other bones via muscles and tendons. The muscles are what contract to move bones like a lever and pulley system. The actual attachment of the muscle to bone is via a shiny slick fibrous tissue known as a tendon.


    Ligaments, on the other hand, are thick strong fibrous material that helps stabilize and attach adjacent bones to one another. For example, the thigh bone or femur is connected to the leg bones (tibia and fibula) at the knee via ligaments that traverse from the far tip of the femur to the near end of the tibia and fibula.  This creates the all important "knee joint capsule" we often hear about. When you extend your leg or run, for instance, the bending of your knee happens because of muscle contractions over the hip, knee and ankle joints as well as others. However, the knee bones stay attached to each other during running because of the action of ligaments.


    A strain is a tear of muscle fibers. Often, one will hear of a strained hamstring or a strained low back. This means that fibers in those muscles have been torn. In a mild strain, there may be only small muscle fibers or micro fibers that are torn. In a severe strain, larger fibers of muscle may be torn, and, of course, in the worst case scenario, an entire muscle may be torn, an extreme form of strain. The results can be something as simple as a few days to a week of mild discomfort in and around the muscle, to debilitating pain and weakness lasting months.


    A sprain, on the other hand, is a tear of ligament fibers that, again, may vary from mild with only a few small or micro fibers tearing, to complete tears of ligaments that have ended careers for some athletes. The dreaded ACL (anterior cruciate ligament) is the most well known, but there are many others. Treatment of strains usually involves rest, non steroidal anti-inflammatory medications such as ibuprofen or naproxen and possibly muscle relaxants. Depending on the severity of the strain, one might also require physical therapy to strengthen and rehabilitate the muscle. Your primary care provider and possibly an orthopedist will help you determine the best regimen. Imaging studies are often unnecessary unless you are a professional athlete.


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    On the other hand, treatment for sprains may also involve rest and non steroidal medications, but will often warrant an imaging study such as an MRI to assess the degree of the sprain and whether surgery will be necessary. Of course, physical therapy and rehabilitation are often necessary whether or not surgery is performed and your primary care provider in conjunction with an orthopedist will come up with a plan that best fits your situation.


    As far as prevention goes, I'd suggest always warming up before vigorous activity, perhaps with some brisk walking or jogging. Stretching after your activity may also help keep muscles limber. Also, strengthening muscles around various joints can help stabilize the joint and take some of the work off of the ligaments. As always, please contact your primary care provider before starting any form of exercise program, or if you think you may have strained or sprained a muscle or ligament respectively.

Published On: September 22, 2008