Sprains and strains

Signs and Symptoms

Symptoms of strains include:

• Muscle stiffness, tenderness, or soreness
• Swelling

Symptoms of sprains include:

• Pain at the time of injury
• Swelling
• Bruising

The joint may be unstable or you may not be able to use the affected part of your body 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, like 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 muscles to stretch and bear weight at the same time. Being injured before or having limited flexibility may contribute to sprains. You are at risk for a sprain or strain if you:

• 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 Doctor's Office

Your doctor may take an x-ray. If your injury is severe, your doctor 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 doctor may recommend that you treat the injured area with R.I.C.E.: rest, ice, compression, and elevation. Use ice wrapped in a cloth or a towel. DO NOT apply ice directly to the skin. Apply R.I.C.E. as needed over the first several days after your injury. There is no evidence to show R.I.C.E. works, but doctors still believe it is helpful.

Ice reduces pain, bleeding, and inflammation. It may also reduce more damage to other parts of the joint. Some evidence suggests that applying ice and using nonsteroidal anti-inflammatory drugs (NSAIDs) helps you heal faster. 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 medicines usually help. You should ask your doctor about the right dose for you. DO NOT use over-the-counter pain relievers for more than 2 weeks. Also, DO NOT 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) or clopidogrel (Plavix). They include:

• Aspirin -- DO NOT give aspirin to children under 18, due to the risk of Reyes syndrome, a potentially fatal condition.
• Naproxen (Aleve)
• Ibuprofen (Advil, Motrin)

Pain-relief creams. Studies show that applying topical diclofenac diethylamine (DDEA) 2.3% gel twice daily helps relieve pain, improve function, and speeds up recovery time.

Acetaminophen (Tylenol). 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.

• Vitamin C and beta-carotene. The body uses vitamin C and beta-carotene to create connective tissue. They may also reduce pain. Vitamin C supplements may interact with other medications, including chemotherapy drugs, estrogen, warfarin (Coumadin), and others.
• Bromelain. This enzyme that comes from pineapples reduces inflammation and swelling. People who are sensitive or allergic to pineapple should avoid using bromelain as it may cause an allergic reaction. People with stomach ulcers should avoid bromelain. If taken with antibiotics, bromelain may increase the levels of antibiotic in the body, which could be dangerous.
• Zinc. May help wounds heal faster. Zinc may interfere with a number of antibiotics and with the chemotherapy drug cisplatin.
• 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. They are often combined in one supplement. Glucosamine and chondroitin can increase the risk of bleeding, especially if you already take blood thinners, such as warfarin (Coumadin) or clopidogrel (Plavix). Glucosamine may interfere with medications used to treat cancer. Ask your doctor before taking glucosamine and chondroitin.

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

• Turmeric (Curcuma longa). For pain and inflammation. Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger. Turmeric may increase the risk of bleeding, so people who take anticoagulants (blood thinners), such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, should not take turmeric without first talking to their doctors. DO NOT take turmeric if you have gallstones or gallbladder issues.
• White willow (Salix alba). To relieve pain. Willow acts similarly to aspirin. DO NOT take white willow if you are also taking aspirin or blood-thinning medications. DO NOT take willow bark products if you are allergic to aspirin or salicylates. Willow should not be given to children under the age of 18. If you have kidney issues, speak to your doctor before taking white willow.
• 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 to 3 hours.

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, includes 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 fail.
• 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 tendinitis, 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 appears to help sprains and strains. One study of 20 people found that acupuncture improved feelings of soreness. Other studies show no benefit. 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 sprains and strains.

Many people visit chiropractors for sprain and strain injuries. In addition to joint manipulation, chiropractors use other treatments for sprains and strains, such as using ice, heat, ultrasound, or electrical muscle stimulation. Chiropractors may also recommend stretching and strengthening exercises to help you recover. One study found that a balance training program 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 worked as well as the anti-inflammatory medication in improving pain and flexibility. It worked better than the medication in improving range of motion.

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

Following Up

Your doctor will probably not 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.

Supporting Research

Bendahou M, Khiami F, Saidi K, et al. Compression stockings in ankle sprain: a multicenter randomized study. Am J Emerg Med. 2014;32(9):1005-1010.

Bleakley CM, McDonough SM, MacAuley DC. Some conservative strategies are effective when added to controlled mobilisation with external support after acute ankle sprain: a systematic review. Aust J Physiother. 2008;54(1):7-20.

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.

Dalton JD, Schweinle JE. Randomized controlled noninferiority trial to compare extended release acetaminophen and ibuprofen for the treatment of ankle sprains. Ann Emerg Med. 2006;48(5):615-623.

Derry S, Moore RA, Gaskell H, McIntyre M, Wiffen PJ. Topical NSAIDs for acute musculoskeltal pain in adults. Cochrane Database Syst Rev. 2015;6:CD007402.

Fan Y, Wu Y. Effect of electroacupuncture on muscle state and infrared thermogram changes in patients with acute lumbar muscle sprain. J Tradit Chin Med. 2015;35(5):499-506.

Hewitt DJ, Todd KH, Xiang J, Jordan DM, Rosenthal NR. Tramadol/acetaminophen and hydrocodone/acetaminophen for the treatment of ankle sprain: a randomized, placebo-controlled trial. Ann Emerg Med. 2007;49(4):468-480, 480.e1-2.

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Jones P, Dalziel SR, Lamdin R, Miles-Chan JL, Frampton C. Oral non-steroidal anti-inflammatory drugs versus other oral analgesic agents for acute soft tissue injury. Cochrane Database Syst Rev. 2015;7:CD007789.

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;11:470-477.

Lathia AT, Jung SM, Chen LX. Efficacy of acupuncture as a treatment for chronic shoulder pain. J Altern Complement Med. 2009;15(6):613-618.

McGuine TA, Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med. 2006;34(7):1103-1111.

Milgrom C, Radeva-Petrova DR, Finestone A, et al. The effect of muscle fatigue on in vivo tibial strains. J Biomech. 2007;40(4):845-850.

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Predel HG, Hamelsky S, Gold M, Giannetti B. Efficacy and safety of diclofenac diethylamine 2.32% gel in acute ankle sprane. Med Sci Sports Exerc. 2012;44(9):1629-1636.

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