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Sprains and strains

• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Following Up
• Special Considerations
• Supporting Research

Sprains and strains are usually minor injuries that often result from sports or exercise, but can easily result from any physical activity. Sprains refer to an injury to a ligament (the connective tissue that links bones together at joints), most often in the ankle, knee, elbow, or wrist. Strains are tears in muscle tissue, commonly occurring in the muscles that support the calf, thigh, groin, and shoulder. Sometimes sprains and strains can be severe, leading to 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 result from a twisting force applied to a joint while it is bearing weight, which causes the ligament to stretch beyond its natural limit. Sprains usually occur with sudden, unexpected movement (a fall or a twist). Muscle strains occur when the weight load on a muscle is greater than the weakest part of the muscle can bear. Strains usually happen during activities that require your muscle to stretch and bear weight at the same time. 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

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 also order an 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 probably will recommend that you treat the injury with RICE: rest, ice (wrapped in a cloth or a towel -- do not apply ice directly to the skin), compression, and elevation of the affected area. Apply RICE as needed over the first several days following the injury.

Ice reduces pain, bleeding, and inflammation. It may also reduce secondary damage to other parts of the joint. Bleeding and inflammation may play an important role in the healing process. For more severe cases, wrap the affected area in an elastic bandage. A cast may be required to stabilize injuries.

You should limit activity that involves the affected area for an average of seven days. You may also be referred to a physical therapist, who will tailor exercises to help you strengthen muscles, joints, and ligaments.

Drug Therapies

Over-the-counter pain relievers (analgesics) and anti-inflammatory agents usually help. However, you should talk to your doctor for adequate dosing. When injuries are more severe or chronic, continued use of analgesics may lead to aggravation of the condition. Analgesics should not be used to mask pain so that you can resume activity without immobilizing the injured area.

• Aspirin -- 325 mg, 1 to 2 tablets every 4 hours
• Naproxen -- 210 mg, 2 to 3 tablets every 8 to 12 hours
• Ibuprofen -- 200 mg, 2 to 3 tablets every 4 to 6 hours
• Analgesic balms
• Acetaminophen -- 325 mg, 1 to 2 tablets every 4 hours

Complementary and Alternative Therapies

Specific 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) both help the body produce connective tissue and may reduce pain.
• Bromelain (250 - 500 mg three times a day between meals), an enzyme derived from pineapple, has anti-inflammatory effects and helps reduce swelling.
• Zinc (15 - 30 mg per day) helps wounds heal faster.
• Vitamin E (400 IU/day) has antioxidant effects.
• Glucosamine and chondroitin, popular supplements for arthritis, may also help wounds heal faster, though studies are lacking. 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 get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should 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.
• Applied topically, 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.
• Applied topically, a gel containing comfrey ( Symphytum officinale ) may also help reduce pain and swelling.You should use comfrey only topically. Do NOT take internally.
• 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.

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. In homeopathic terms, a person's constitution is his or her 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 skin the 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.

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 condition.

Chiropractic

Chiropractors commonly treat sprain and strain injuries, particularly those with pain and diminished function. A significant number of people who visit chiropractors do so for sprain and strain injuries. In addition to joint manipulation, chiropracters use other treatments for sprains and strains, such as applications of ice and heat and ultrasound or electrical muscle stimulation. Stretching and strengthening exercises are also often recommended to aid recovery and rehabilitation.

In a study of people with ankle sprains, researchers compared the effectiveness of 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, but it was more effective than the medication in improving range of motion.

Massage

Therapeutic massage is effective at increasing circulation and may relieve spasm in surrounding muscle groups.

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

Be careful of recurring sprains and strains. Once a muscle or tendon is injured, it is susceptible to reinjury, 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.

Supporting Research

Balch JF, Balch PA. Prescription for Nutritional Healing. Garden City Park, NY: Avery Publishing Group; 1997.

Birrer RB, ed. Sports Medicine for the Primary Care Physician. Boca Raton, Fla: CRC Press; 1994.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:429.

Calabrese C, Preston P. Report of the results of a double-blind, randomized, single-dose trial of a topical 2% escin gel versus placebo in the acute treatment of experimentally-induced hematoma in volunteers. Planta Med . 1993;59:394–397.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Coetzer D, Brantingham J, Nook B. The relative effectiveness of piroxicam compared to manipulation in the treatment of acute grades 1 and 2 inversion ankle sprains. Journal of the Neuromusculoskeletal System . 2001;9(1):1-12.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3 ^rd ed. New York, NY: Penguin Putnam; 1997: 286-287.

Guillaume M, Padioleau F. Veinotonic effect, vascular protection, anti-inflammatory and free radical scavenging properties of horse chestnut extract. Arzneimittelforschung 1994;44:25–35.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 138-139.

Kibler WB, Herring S, Press J, Lee P. Functional Rehabilitation of Sports and Musculoskeletal Injuries. Gaithersburg, Md: Aspen Publishers; 1998.

Koll R, Buhr M, Dieter R, et al. Efficacy and tolerance of a comfrey root extract (Extr. Rad. Symphyti) in the treatment of ankle distorsions: results of a multicenter, randomized, placebo-controlled, double-blind study. Phytomedicine . 2004;11:470-7.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Lin JG, Yang SH. Effects of acupuncture on exercise-induced muscle soreness and serum creatine kinase activity. Amer J Chin Med. 1999;27(3-4):299-305.

Mazzotta MY. Nutrition and wound healing. J Am Podiatr Med Assoc 1994;84:456–62 [review].

McCarty MF. Glucosamine for wound healing. Med Hypotheses 1996;47:273–5 [review].

Null G. The Clinician's Handbook of Natural Healing. New York, NY: Kensington Publishing Corp; 1997.

Nyiendo J, Lamm L. Disabling low back Oregon workers' compensation claims. Part I: Methodology and clinical categorization of chiropractic and medical cases. J Manipulative Physiol Ther. 1991;14(3):177-184.

Olshevsky M, Noy S, Zwang M, Burger R. Manual of Natural Therapy. New York, NY: Facts on File; 1989.

Strauss RH, ed. Sports Medicine. Philadelphia, Pa: WB Saunders Co; 1991.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 126-127.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 335.

Zachazewski JE, Magee DJ, Quillen WS. Athletic Injuries and Rehabilitation. Philadelphia, Pa: WB Saunders Co; 1996.

• Review Date: 6/30/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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