Sprains, Strains and Pulls

by Peter on July 7, 2011

So many sticks!

Lucy, my 5 year old Airedale loves sticks. And loves water. Combined she goes nuts and will swim out into any ocean to retrieve a stick. However a few weeks ago she lept  into the ocean, got the stick, but came out lame, holding her back left leg in the air. Muscle pull, sprain, strain, whatever you want to call it, she had one of them. After a thorough check I determined it to be a muscle strain. This of coarse reminded me of being in the office. So many times patients ask the difference between all of these. We’ve all gone over on our ankle, but many people are not sure what to do when this happens. So in this weeks segment I will explain the differences and what it means to your recovery.


A sprain is an injury to a joint ligament. Ligaments are the strong bands of tissue that connect one bone to another at a joint. The severity of the injury can be classified by the amount of tissue tearing, joint stability, pain and swelling. The mildest sprain (first degree) has little tearing, pain or swelling, and joint stability is good. The second degree sprain has the broadest range of damage, with moderate instability, and moderate to severe pain and swelling. The most serious sprain is a third degree sprain. The ligament is completely ruptured and the joint is unstable. There may be severe pain at first, but afterward there may be no pain. There will be a lot of swelling with this type of sprain, and often other tissues are damaged.

Signs and Symptoms of Sprains

The usual signs and symptoms of a muscle sprain include pain, swelling, bruising, and the loss of functional ability (the ability to move and use the joint). Sometimes people feel a pop or tear when the injury happens. However, these signs and symptoms can vary in intensity, depending on the severity of the sprain.

Sprain Severity

Grade I Sprain:

A grade I (mild) sprain causes overstretching or slight tearing of the ligaments with no joint instability. A person with a mild sprain usually experiences minimal pain, swelling, and little or no loss of functional ability. Bruising is absent or slight, and the person is usually able to put weight on the affected joint.

Grade II Sprain:

A grade II (moderate) sprain causes partial tearing of the ligament and is characterized by bruising, moderate pain, and swelling. A person with a moderate sprain usually has some difficulty putting weight on the affected joint and experiences some loss of function. An x-ray or MRI may be needed.

Grade III Sprain:

A grade III (severe) sprain results in a complete tear or rupture a ligament. Pain, swelling, and bruising are usually severe, and the patient is unable to put weight on the joint. An x-ray is usually taken to rule out a broken bone. This type of a muscle sprain often requires immobilization and possibly surgery. It can also increase the risk of an athlete having future muscles sprains in that area.


A strain is damage to muscle fibers and to the other fibers that attach the muscle to the
bone. Other names for a strain include “torn muscle,” “muscle pulls” and “ruptured tendon.” Muscle injuries are classified from first (least severe) to third (most severe) degree strains. A first degree strain has little tissue tearing, mild tenderness and pain with full range of motion. As with the sprains, the second-degree strain has a wide variability. Muscle or tendon tissues have been torn, resulting in very painful, limited motion. There may be some observable swelling or a depression at the spot of the injury with a second degree strain. The third-degree strain involves complete rupture of a part of the muscle unit. Motion will be severely decreased or absent. Pain will be severe at first, but the muscle may be painless after the initial injury.

Common Types of Strains

Ankle Sprains
: The ankle is one of the most common injuries in professional and recreational sports and activities. Most ankle sprains happen when the foot abruptly turns inward (inversion) or outward (eversion) as an athletes runs, turns, falls, or lands after a jump. One or more of the lateral ligaments are injured.
Wrist Sprains
Wrists are often sprained after a fall in which the athlete lands on an outstretched hand.

Acute Treatment of Strains

There are several decisions that you must make when you injure yourself. Among the first of these is how serious the injury is and whether you should go to a healthcare provider. Look for deformities, significant swelling and changes in skin color. If there are deformities, significant swelling or pain you should immobilize the area and seek medical help. Many fractures will not cause a deformity, thus if there is any doubt or concern you should get medical attention.

Stage One

Management of both sprains and strains follows the “PRICE” principle.

P – Protect from further injury
R – Restrict activity
I – Apply Ice
C – Apply Compression
E – Elevate the injured area

This principle limits the amount of swelling at the injury and improves the healing process. Splints, pads and crutches will protect a joint or muscle from further injury when appropriately used (usually for more severe sprains or strains). Activity restriction (usually for 48-72 hours) will allow the healing process to begin. During the activity restriction, gentle movement of the muscle or joint should be started. Ice should be applied for 15 to 20 minutes every hour to hour and a half. Compression, such as an elastic bandage, should be kept on between icing; you may want to remove the bandage while sleeping, though keeping it compressed even during the night is best. Elevating the limb will also keep the swelling to a minimum. Acute treatment is the first stage of rehabilitation.


If you suspect more than a mild injury, cannot put weight on the limb, or it gives way, you should consult with a healthcare provider.


Following the first 48 to 72 hours, it is important to start the next stage of rehabilitation. The second stage of rehabilitation focuses on gentle movement of the muscle or joint, mild resistive exercise, joint position training and continued icing. When you are able to move without pain you can progress to the next stage of rehabilitation.

During this stage you may gradually return to more strenuous activities, such as strengthening. A simple guide to how much you can do is pain. Pain should remain low during rehabilitation; if pain increases it usually means you have attempted to do too much.

Throughout your recovery you can still maintain an aerobic training program. Options for training include stationary bicycling, swimming, walking or running in the water. If the injury is more than mild sprain or strain it is best to consult your healthcare provider.

Stage Two (after initial 48-72 hours swelling has stopped increasing and pain decreases)

Range of Motion

Towel pull with toes
Draw the alphabet with ankle

Mild Resistive Exercises

Foot press—up, down and each side, against a solid object (no motion of the ankle) Tubing exercises in all motions (pain free)

Joint Position

Standing with eyes closed—partial squats and shifts from side to side

Stage Three (pain free; can walk without limp)

Range of Motion

Stretching with Towel


Toe Raises
Hops—start forward and back, short hops

Weights—Heavy tubing or cuff weights

Joint Position

One-legged stand with eyes closed


Understanding what is going on with your injury promotes quick and proper care. If you have any questions or concerns please do not hesitate to contact me. Oh, and Lucy, she is back to her energetic, clown like self.


In Health,


Peter Roach, RMT, CNMT, Laser Therapist

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