Introduction:

Sprains and strains are usually minor injuries that often result from sports, exercise, or other physical activity. Sprains refer to an injury to a ligament (the connective tissue that links bones together at joints). Sprains happen most often in the ankle, knee, elbow, or wrist. Strains are tears in muscle tissue. They happen most often in the muscles that support the calf, thigh, groin, and shoulder. Sometimes sprains and strains can be severe, needing weeks of rehabilitation.

Signs and Symptoms:

Strains:

• Muscle stiffness, tenderness, or soreness
• Swelling

Sprains:

• Pain at the time of injury
• Swelling
• Bruising

You may have joint instability or disability if the injury is serious, involving a muscle or ligament tear.

What Causes It?:

Sprains generally happen when a twisting force is applied to a joint while it is bearing weight, which causes the ligament to stretch beyond its usual limit. Sprains tend to happen with sudden, unexpected movement (a fall or a twist). Muscle strains happen when the weight on a muscle is greater than the weakest part of the muscle can bear. Strains tend to happen during activities that require your muscle to stretch and bear weight at the same time. Some evidence suggests that being injured before or having limited flexibility contributes to sprains. You are at risk for a sprain or strain if you do the following:

• Exercise without warming up properly
• Use athletic equipment that does not fit properly
• Participate in sports and activities that you are not conditioned for
• Exercise when bones and muscles are fatigued

What to Expect at Your Provider's Office:

Your health care provider may take an x-ray. If your injury is severe, your health provider may order other imaging tests, such as magnetic resonance imaging (MRI). Your injured limb may need to be wrapped in an elastic bandage or put in a soft cast.

Treatment Options:

Your health care provider may recommend that you treat the injury with RICE: rest, ice, compression, and elevation of the injured area. Use ice wrapped in a cloth or a towel -- do not apply ice directly to the skin. Apply RICE as needed over the first several days after your injury.

Ice reduces pain, bleeding, and inflammation. It may also reduce secondary damage to other parts of the joint. Some evidence suggests that applying ice and using nonsteroidal anti-inflammatory drugs (NSAIDs) improves healing and speeds recovery. For more severe cases, wrap the affected area in an elastic bandage. You may need a cast to stabilize injuries.

Rest the injured area for about 7 days. Your doctor may refer you to a physical therapist, who will give you exercises to help you strengthen muscles, joints, and ligaments.

Drug Therapies

Over-the-counter pain relievers (analgesics) and anti-inflammatory agents usually help. You should ask your doctor about the right dose for you. Don' t use over-the-counter pain relievers for more than 2 weeks, and don' t use pain relievers to mask the pain so you can keep using the injured area.

• NSAIDs -- reduce pain, inflammation, and swelling. These drugs may increase the risk of bleeding, so do not take them if you take blood-thinning medication such as warfarin (Coumadin). They include:
  • Aspirin -- 325 mg, 1 - 2 tablets every 4 hours. Do not give aspirin to children under 18, due to the risk of Reyes syndrome, a potentially fatal condition.
  • Naproxen (Aleve) -- 210 mg, 2 - 3 tablets every 8 - 12 hours
  • Ibuprofen (Advil, Motrin) -- 200 mg, 2 - 3 tablets every 4 - 6 hours
• Analgesic balms
• Acetaminophen (Tylenol) -- 325 mg, 1 - 2 tablets every 4 hours. Do not take more than the recommended dose of acetaminophen. High doses can lead to liver damage.

Complementary and Alternative Therapies

Some nutrients and herbs may help the body restore damaged tissue, reduce swelling, and provide pain relief.

Nutrition and Supplements

• Vitamin C (250 - 500 mg two times a day) and beta-carotene (50,000 IU per day for 5 days) – The body uses both to create connective tissue. They may also reduce pain.
• Bromelain (250 - 500 mg three times a day between meals) -- This enzyme derived from pineapple has anti-inflammatory effects and helps reduce swelling. Bromelain may increase the risk of bleeding, so talk to your doctor before taking it if you also take NSAIDs or blood-thinning medication.
• Zinc (15 - 30 mg per day) -- may help wounds heal faster.
• Glucosamine and chondroitin – These are popular supplements for osteoarthritis that may help rebuild connective tissue. Some researchers think they may also help wounds heal faster, although there is no scientific evidence of that. Usual doses are: glucosamine, 1,500 per day; chondroitin, 800 - 1,200 mg per day, divided in two to four doses. They are often combined in one supplement.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your provider to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Turmeric (Curcuma longa) -- helps reduce swelling and makes the effect of bromelain stronger. Take 250 - 500 mg each of turmeric and bromelain, three times a day between meals. Turmeric may increase the risk of bleeding, so talk to your doctor before taking it if you also take NSAIDs or blood-thinning medication.
• White willow (Salix alba) -- acts similar to aspirin and can reduce inflammation and swelling. Make a tea by boiling 1/2 teaspoon (2 grams) of bark in 8 ounces of water. Drink up to 5 cups per day. If you are allergic to aspirin or salicylates, check with your doctor before using white willow. White willow may increase the risk of bleeding, so talk to your doctor before taking it if you also take NSAIDs or blood-thinning medication.
• Applied topically (to the skin), the active ingredient in horse chestnut (Aesculus hippocastanum), called aescin, may reduce tenderness and swelling. Apply a gel with 2% aescin to the affected area every 2 - 3 hours.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for sprains and strains based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Arnica (topical) -- this remedy is generally considered the first-choice homeopathic treatment for acute injury. It is applied topically in addition to an appropriate internal remedy. You should not use arnica, however, if the skin has open cuts over the injured area.
• Arnica (internal) -- for injuries with swelling, bruising, and inflammation. You should switch to another appropriate remedy once swelling has subsided.
• Bryonia -- for swollen injuries that get worse with movement. This remedy is especially useful for chest, shoulder, and hamstring injuries. It is often used if Arnica or Rhus toxicodendron fails.
• Ledum -- for sprained ankles that feel cold or numb but improve with cold applications (such as ice) and worsen with warm applications.
• Rhus toxicodendron -- this remedy is used after the initial symptoms of an injury have improved (such as from using Arnica). For pain during initial movement that subsides with more movement. The affected area generally feels hot. This remedy is especially appropriate for lifting or overexertion injuries.
• Ruta -- for tendonitis, torn ligaments, and other injuries that feel hot to the touch. Ruta is very useful as a treatment for overexertion injuries, such as tennis elbow and runner's knee. Symptoms tend to be worse with initial movement, but continued motion does not bring relief.
• Traumeel -- a proprietary formula, for management of mild to moderate injuries. One study found that Traumeel was as effective as conventional medicines for reducing the pain and inflammation associated with injuries, such as sprains, strains, and contusions.

Acupuncture

Acupuncture appears to be effective for sprains and strains. One study of 20 people found that acupuncture improved feelings of soreness. Acupuncturists often apply moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) in combination with needling in order to strengthen or deepen the treatment for this sprains and strains.

Chiropractic

Many people who visit chiropractors do so for sprain and strain injuries. In addition to joint manipulation, chiropractors use other treatments for sprains and strains, such as using ice and heat and ultrasound or electrical muscle stimulation. Chiropractors may also recommend stretching and strengthening exercises to aid recovery. One study found that a balance training program significantly reduced the risk of ankle sprains among high school soccer and basketball players.

In a study of people with ankle sprains, researchers compared chiropractic joint manipulation with an anti-inflammatory medication. They found that joint manipulation was as effective as the anti-inflammatory medication in improving pain and flexibility. It was more effective than the medication in improving range of motion.

Massage

Therapeutic massage may help increase circulation and may relieve spasm in surrounding muscles.

Following Up:

Your health care provider probably won't need to see you again unless your injury was severe or you have complications.

Special Considerations:

Once a muscle or tendon is injured, it is susceptible to injury again, especially if you return to full activity too soon. Sprains and strains are easy to prevent. Basic physical fitness and strength training with proper warm-up and cool-down reduce the stress to muscles and joints.