Sprains

Overview

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. Mild sprains can be successfully treated at home. Severe sprains sometimes require surgery to repair torn ligaments.

The difference between a sprain and a strain is that a sprain injures the bands of tissue that connect two bones together, while a strain involves an injury to a muscle or to the band of tissue that attaches a muscle to a bone.

Symptoms

Signs and symptoms will vary, depending on the severity of the injury, and may include:

• Pain
• Swelling
• Bruising
• Limited ability to move the affected joint
• Hearing or feeling a "pop" in your joint at the time of injury

When to see the doctor

Mild sprains can be treated at home. But the injuries that cause sprains can also cause serious injuries, such as fractures. You should see a doctor if you:

• Can't move or bear weight on the affected joint
• Have pain directly over the bones of an injured joint
• Have numbness in any part of the injured area

Causes

A sprain occurs when you overextend or tear a ligament while severely stressing a joint. Sprains often occur in the following circumstances:

• Ankle — Walking or exercising on an uneven surface, landing awkwardly from a jump
• Knee — Pivoting during an athletic activity
• Wrist — Landing on an outstretched hand during a fall
• Thumb — Skiing injury or overextension when playing racquet sports, such as tennis

Children have areas of softer tissue, called growth plates, near the ends of their bones. The ligaments around a joint are often stronger than these growth plates, so children are more likely to experience a fracture than a sprain.

Risk factors

Factors contributing to sprains include:

• Environmental conditions. Slippery or uneven surfaces can make you more prone to injury.
• Fatigue. Tired muscles are less likely to provide good support for your joints. When you're tired, you're also more likely to succumb to forces that could stress a joint.
• Poor equipment. Ill-fitting or poorly maintained footwear or other sporting equipment can contribute to your risk of a sprain.

Prevention

Regular stretching and strengthening exercises for your sport, fitness or work activity, as part of an overall physical conditioning program, can help to minimize your risk of sprains. Try to be in shape to play your sport; don't play your sport to get in shape. If you have a physically demanding occupation, regular conditioning can help prevent injuries.

You can protect your joints in the long term by working to strengthen and condition the muscles around the joint that has been injured. The best brace you can give yourself is your own "muscle brace." Ask your doctor about appropriate conditioning and stability exercises. Also, use footwear that offers support and protection.

Diagnosis

During the physical exam, your doctor will check for swelling and points of tenderness in your affected limb. The location and intensity of your pain can help determine the extent and nature of the damage.

X-rays can help rule out a fracture or other bone injury as the source of the problem. Magnetic resonance imaging (MRI) also may be used to help diagnose the extent of the injury.

Treatment

For immediate self-care of a sprain, try the R.I.C.E. approach — rest, ice, compression, elevation:

• Rest. Avoid activities that cause pain, swelling or discomfort. But don't avoid all physical activity.
• Ice. Even if you're seeking medical help, ice the area immediately. Use an ice pack or slush bath of ice and water for 15 to 20 minutes each time and repeat every two to three hours while you're awake for the first few days after the injury.
• Compression. To help stop swelling, compress the area with an elastic bandage until the swelling stops. Don't wrap it too tightly or you may hinder circulation. Begin wrapping at the end farthest from your heart. Loosen the wrap if the pain increases, the area becomes numb or swelling is occurring below the wrapped area.
• Elevation. Elevate the injured area above the level of your heart, especially at night, which allows gravity to help reduce swelling.

Over-the-counter pain medications such as ibuprofen (Advil, Motrin IB, others) and acetaminophen (Tylenol, others) also can be helpful.

After the first two days, gently begin to use the injured area. You should see a gradual, progressive improvement in the joint's ability to support your weight or your ability to move without pain. Recovery from sprains can take days to months.

A physical therapist can help you to maximize stability and strength of the injured joint or limb. Your doctor may suggest that you immobilize the area with a brace or splint. For some injuries, such as a torn ligament, surgery may be considered.

Preparing for an appointment

While you may initially consult your family physician, he or she may refer you to a doctor who specializes in sports medicine or orthopedic surgery.

What you can do

You may want to write a list that includes:

• Detailed descriptions of your symptoms
• Information about medical problems you've had
• Information about the medical problems of your parents or siblings
• All the medications and dietary supplements you take
• Questions you want to ask the doctor

What to expect from your doctor

Your doctor may ask some of the following questions:

• How exactly were you moving when the injury occurred?
• Did you hear or feel a pop or snap?
• When did it happen?
• What types of home treatments have you tried?
• Have you ever injured this part of your body before?
• If so, how did that injury occur?