Sprains, Strains And Tears

Sprains, strains and tears are a hot topic in the physiotherapy world

As physiotherapists we come across these types of injuries daily, but what does that mean for you? Keep reading to find out what the differences are between each of these, the physiotherapy treatment involved, and even how to avoid them recurring (or happening at all!)

Ligament vs tendon vs muscle

Let’s start with muscles. So what are they? Muscles are soft tissues. Many stretchy fibers make up your muscles. You have more than 600 muscles in your body. Different types of muscles have different jobs. Some muscles help you run or jump, others perform delicate tasks like threading a needle. Ligaments and tendons on the other hand, are quite different from muscles and even from each other!

Tendons serve the purpose of attaching our muscles to our bones. They act like an anchor for the muscle to the bone.

Ligaments attach bone to bone. Now you may think that ligaments are kind of the outlier in this situation. However the example of the calf complex sums it up perfectly! From the outside it looks as though the foot is just attached to the lower leg which naturally becomes the calf. While this is not wrong, what's going on underneath is much more interesting! The Achilles tendon, at the back of your heel, attaches the calf muscles to the calcaneus (heel bone), while a ligament holds the shin and foot bones (tibia and fibula with the talus) together at the ankle joint.

So now that we know what’s involved, what happens when something goes wrong? You may often hear people and professionals speak of sprains and tears, but how do we distinguish between them?

Sprain VS tear

A sprain is a stretching or tearing of ligaments — the tough bands of fibrous tissue that connect two bones together in your joints. The most common location for a sprain is in your ankle. Initial treatment includes rest, ice, compression and elevation.

Strains and tears can be grouped together. This is because a severe strain is referred to as a tear. Take a look at the table below to see how we can classify these injuries. 

Grade 1- The signs may not be present until after the activity is over. There may be a sensation of muscle cramp/tightness and a slight feeling of pain when the muscles are stretched or contracted.

Grade 2- Immediate pain which is more severe than that of grade 1. It is confirmed by pain on stretch and contraction of the muscle and is usually sore to touch.

Grade 3- Quite a serious injury. There is an immediate burning/stabbing pain and the individual is unable to walk without pain. The muscle is completely torn and there may be a large lump of muscle tissue above a depression where the tear is. Bruising will appear below the injury site.

Treatment 

Treatment of strains and sprains should begin as soon as possible. Many people are familiar with the “RICE” protocol of Rest, Ice, Compression and Elevation. Research now suggests that we can do a lot more in the early stages of Injury. See the infographic below for the most effective acute injury management protocol - “Peace & Love”.

Your physiotherapist will guide you through a detailed and comprehensive rehabilitation programme individualized to your injury and personal goals. This kind of injury can take time to heal and may change the dynamics of the joint. The degree of sprain will determine the steps you will need to take in the recovery process. As physios, we will work with you to regain strength and mobility in your joint. We will teach you exercises, as well as give you a home exercise program, to prevent the injured joint from becoming stiff. Exercises to build strength and balance (in ankle and knee sprains) will be increased over time until you are back at a pre-injury level of activity. Your physio therapy can help with a return to exercise, sports programs and get the affected joint or muscle even stronger than it was to begin with. If you have suffered repeated sprains or strains (such as an ankle sprain or hamstring strain) or were immobilised for a while as the area healed (like in a boot or cast), physiotherapy will be strongly recommended to reduce the chance of getting injured again.

Using an injured muscle or tendon can make your injury heal faster, as long as it's within the parameters set out by our physiotherapists. 

Exercising strained muscles and tendons may seem counterintuitive but a specific program of gradual strength training actually heals tendons faster. As your body repairs damaged tendons, it lays down fibres of collagen to form a scar, by exposing the scar to mechanical load (resistance exercise) the collagen aligns itself appropriately. Resting completely and avoiding any loading of the damaged tissue causes a phenomenon called ‘collagen disarray’. This essentially means the scar that the body has laid down to repair the tendon is not efficient at transmitting force through the tendon and can increase risk of re-injury, prolonged pain and inflammation.

Our physiotherapists will guide you through your muscle or tendon strain rehabilitation with graded exposure to resistance exercise and functional activities to facilitate optimal healing and a return to your best level of function.

Prevention

Though sprains and strains can happen to anyone, there are a few ways you can reduce the risk of a sprain. These tips include:

• Avoid exercising or playing sports when tired or in pain.

• Maintain a healthy weight and well-balanced diet to keep muscles strong.

• Wear shoes that fit properly and be sure any sports equipment is also fitting well.

• Practice safety measures to prevent falls.

• Do stretching exercises daily or prior physiotherapy exercises to maintain strength and balance.

• Warm up and stretch before doing any physical activity.

If you ever are questioning if you have a muscle/tendon strain/tear or a ligament sprain, always consult your physiotherapist. It’s usually a good idea to make sure it’s only a sprain or strain and not a more severe injury. You can also get a treatment plan that will get you up and moving again.