Thursday, 21 August 2014

Sprain or strain: Know the difference between two common injuries

Ouch time: The first stage of treatment for strains and sprains is RICE – Rest, Ice, Compression and Elevation. – AFP

Ouch time: The first stage of treatment for strains and sprains is RICE – Rest, Ice, Compression and Elevation. – AFP

Sprains and strains are very common injuries that affect muscles and ligaments.

The terms “sprain” and “strain” are often used interchangeably. There is, however, a difference between the two. 

A sprain is a stretch and/or tear of a ligament. A ligament is a band of fibrous tissue that connects two bones at a joint. For example, ligaments connect the tibia (shin bone) to the calcaneum (heel bone) at the ankle. A few ligaments can be injured at the same time and how severe the injury depends on the extent of the tear (partial or complete tear of the ligament) and the number of ligaments involved.

A strain is the same injury to a muscle or a tendon (fibrous tissues that connect muscles to bone). As there is usually only one tendon connecting a muscle to the bone, the extent of injury depends on whether it is merely an overstretch or whether there are complete or partial tears in the muscle or tendon.

What causes sprains and strains?

A sprain usually results from a fall, sudden twist or blow to the body that forces a joint out of its normal position. Sprains usually occur when falling on an outstretched arm or twisting an ankle when landing awkwardly from height or twisting the knee with one foot planted on the ground.

Twisting or pulling of a muscle or tendon in an unusual posture, overworking the muscles with excessive activity or carrying an unusually heavy load causes strains. For instance, neck pain on waking up is usually the result of straining the neck muscles due to abnormal posture maintained during sleep.

A chronic strain can result from overuse – prolonged, repetitive movements of the muscles and tendons.

What are the symptoms?

The usual signs and symptoms would be pain, swelling and/or bruising, and loss of ability to move the joint. There are three grades of sprains. Grade 1 involves a mild over-stretching or slight tearing of a ligament, with no joint instability. A person is usually able to put weight on the affected joint.

A grade 2 sprain is an incomplete tear of the ligament, where there is moderate pain, bruising and swelling, and the person finds it more difficult to put weight on the joint. There is usually some loss of function as well. An x-ray may be needed to rule out a fracture. Sometimes, an MRI is required to differentiate between partial or complete tear of the ligament.

Grade 3 sprains are complete tears where the symptoms are severe and the person is unable to put weight on the joint. A strain causes pain, limited movement, muscle spasms and occasionally weakness. It may also look like a sprain. There is usually localised pain in the affected area and weakness when attempting to move it. Complete or severe partial tears usually cause a lot of pain and disability.

When should you see a doctor?

A doctor should be consulted in the following situations:

> Severe pain on weight bearing.

> Inability to move the affected joint.

> Cannot walk more than four steps without significant pain.

> Limb buckles or gives way.

> Numbness.

> Redness or red streaks on the injured site.

> Pain, redness or swelling over a bony area.

Treatment involves two stages – first to reduce swelling and pain, and then rehabilitation.

The first stage (first 24 to 48 hours) involves RICE – Rest, Ice, Compression and Elevation. You may also take over-the-counter or prescription painkillers to reduce pain and swelling. Rest simply means reducing regular exercise or activities of daily living. Crutches or a walking stick may be needed.

Ice can be applied 20 minutes at a time, four to eight times a day. An ice pack, or simply a plastic bag filled with crushed ice or a bag of frozen peas can be used. Wrap a towel around the ice pack or bag. Remember not to apply for more than 20 minutes as ice can burn the skin!

Compression in the form of bandages, elastic wraps, air cast or special boots and splints can reduce swelling. If applying a bandage, be aware that bandaging too tightly can restrict blood flow and cause more damage. As much as possible, elevate the injured part above the level of the heart to reduce swelling.

More severe sprains and strains may need a hard cast or require surgery, usually performed by the orthopaedic surgeon.

The second phase of treatment, rehabilitation, aims to improve the condition of the injured area and restore its function. Usually, more severe sprains and strains (stiffness, reduced range of motion, reduced function and strength) would require physiotherapy. This is important to reduce swelling, prevent stiffness and restore pain-free range of motion.

A person who has injured his foot or knee would need weight-bearing and balancing exercises. For example, after an ankle sprain, balance receptors are usually damaged, so balancing exercises are needed to re-educate the ankle to prevent a recurrence of the ankle sprain.

Rehabilitation is also needed to increase strength and regain flexibility. This usually starts on the second week after injury by doing more demanding exercises as pain decreases and function improves.

The final goal of rehabilitation is to return to normal daily activities, including sports. Patients would need to work closely with their rehabilitation physicians or sports physicians to determine their readiness to return to full activity.

> This article is contributed by The Star Health & Ageing Panel, which comprises a group of panelists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.

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