Sprains and Strains

What the difference actually is

Ligaments and tendons look similar and are easily confused, but they connect different things. A ligament runs from one bone to another across a joint, and its job is passive: it acts as a check rein that stops the joint moving further than it should. A tendon runs from a muscle to a bone, and its job is active: it transmits the pull the muscle generates so the joint moves. A sprain is an injury to a ligament, and threatens the stability of a joint. A strain is an injury to a muscle or its tendon, and affects power. Put simply, a sprain happens to a joint, a strain to a muscle.

The mechanisms differ accordingly. Sprains occur when a joint is forced past its normal range: rolling an ankle on a curb, a blow to the outside of the knee, or landing on an outstretched hand. Strains occur when a muscle contracts while being lengthened, or must produce force suddenly at speed: a hamstring during a sprint, a calf pushing off. Both range from stretching, through partial tearing, to complete rupture, and that range determines seriousness rather than the pain felt at the time. A complete ligament rupture can be surprisingly painless, while a modest strain can be intensely uncomfortable, which is why self assessment is unreliable.

Symptoms that often bring people in

• Pain at a joint after a twisting or forced movement, with swelling that develops afterward.
• Bruising that appears over the following days, sometimes tracking away from the injury.
• A joint that feels loose or as though it might give way on uneven ground.
• Sudden sharp pain in the back of the thigh or calf during acceleration.
• Weakness, inability to contract a muscle properly, or a visible gap in it.
• A popping sensation at the moment of injury.

How they are evaluated

The mechanism of injury is a large part of the diagnosis, so a physician will ask what position the limb was in, what direction the force came from, and whether you could carry on afterward. Examination locates tenderness along the course of the suspected ligament or muscle and tests the joint with manoeuvres that stress each ligament individually to see whether it holds. For a suspected strain, the muscle is tested against resistance and palpated for a defect. Because a fracture can produce similar symptoms, and because injuries in children may involve the growth plate, X-rays are frequently taken before an injury is labelled a sprain. MRI is used when the extent of a tear needs defining.

Treatment options in general terms

Most sprains and strains are managed without surgery, and early treatment is directed at protecting the injured tissue while it heals.

• Early protective measures. Protection, relative rest, compression and elevation are the familiar first steps; what suits your injury is worth confirming with a physician.
• Support and immobilization. Braces, splints, taping or a walking boot may be used to unload the injured structure.
• Rehabilitation. A progressive program restoring motion, then strength, then balance. Balance retraining matters after ligament injury, because ligaments carry position sensors disrupted along with the tissue.
• Medication categories. Pain relieving and anti-inflammatory options discussed in the context of your general health.

Surgery is the exception rather than the rule and is generally considered for complete tears or for instability that persists.

• Ligament repair or reconstruction. Restoring stability when a ligament has ruptured and the joint remains unstable, by repair or with a graft.
• Tendon repair. Reattaching a tendon that has torn completely or pulled away from bone.
• Fixation of avulsion injuries. Securing a fragment of bone pulled off by the ligament or tendon attached to it.

What to expect when you consult Dr. Wolfson

Dr. Wolfson treats sports injuries and orthopedic trauma in athletes and in people who simply want to get back to normal activity, and works toward the most conservative treatment that will resolve the injury. He will establish the mechanism, examine the joint or muscle and test its stability, and explain whether the injured tissue is a ligament or a tendon.

This page provides general information about sprains and strains and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]