Sprains and Strains: Differences
For the first day or two after an injury, wrap a sprain or strain in compression bandages.
- Sprains and strains are common orthopedic injuries.
- A sprain is an injury to a ligament, and a strain is an injury to a muscle or tendon.
- A sprain is usually caused by trauma to a joint. A strain is usually the result of overstretching or overuse of muscles and tendons.
- People at higher risk for sprains and strains include athletes, people who have had sprains and strains before, and those who are overweight.
- Signs and symptoms of sprains and strains include pain, swelling, bruising, and decreased range of motion.
- The main treatment (first aid) for all sprains and strains is RICE: rest, ice, compression, and elevation.
- Home remedies may include over-the-counter pain relievers. Physical therapy or massage may also be prescribed.
- Most sprains and strains heal completely with adequate treatment, though you will be at higher risk of re-injuring the same area again.
- Prevent sprains and strains by stretching and conditioning, wearing the proper shoes for sports, and maintaining a healthy weight.
What Are Sprains and Strains?
- Sprains and strains are common orthopedic injuries.
- A sprain is an injury to a ligament, which is a band of tissue that connects one bone to another.
- A strain is an injury to a muscle or tendon, which is a band of tissue that connects muscle to bone.
- A strain is also sometimes referred to as a "torn muscle" or "muscle pull."
These injuries can occur in any body part but are most often found in the lower and upper extremities, such as the ankle, knee, elbow, or wrist. The most common sprain site is the ankle joint. More than 23,000 ankle sprains are estimated to occur daily in the United States. Ankle sprains can occur where the foot falls inward (inversion) or when the foot twists out (eversion). The most common muscle strain sites are the lumbar spine (lower back) and the hamstring muscle in the back of the thigh. Some sprains and strains may occur together during the same injury process.
What Are Symptoms and Signs of Sprains and Strains?
Sprains tend to have symptoms more localized to the injured joint. When the joint is injured, it's possible to feel a tear or pop in the joint. Pain is usually immediate, and depending on the severity of the injury, it may not be possible to use the joint. Signs and symptoms of sprains include
- instability of the joint, and
- decreased range of motion.
Strains, whether acute or chronic, have symptoms localized to the muscle groups or tendons that are injured. Pain can be over a small area, or a larger area, such as a group of muscles. Pain can be immediate in an acute strain, or it may be delayed in the case of an overuse injury. Signs and symptoms of strains include
- muscle spasm,
- muscle cramping,
- muscle weakness, and
- bruising may occur but may be delayed for several days.
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What Causes Sprains and Strains?
A sprain is usually caused by trauma to a joint (the space between bones).
- Twisting or forces overstretch the ligaments (such as hyperextension or hyperflexion) and can cause tears in the ligament tissue, which can be graded from mild to severe depending on the amount of damage.
- Sprains can happen when people twist an ankle or knee or fall on an elbow or shoulder.
A strain is usually the result of overstretching or overuse of muscles and tendons.
- An acute strain can be the result of sudden twisting or trauma to the muscles or tendons.
- Chronic strains are the consequence of overuse of muscles and tendons, such as with athletes who train constantly and do not rest adequately.
What Are Risk Factors for Sprains and Strains?
Anyone can get a sprain or strain, however, some people may be at higher risk, including the following people:
- Jumping sports (for example, basketball, volleyball) carry a higher risk of foot, knee, and ankle strains and sprains.
- Gymnastics, tennis, and golf carry a higher risk of hand, wrist, elbow, rotator cuff, and arm strains and sprains.
- Contact sports (for example, hockey and football) carry a higher risk of sprains and strains of any type, including but not limited to the fingers, thumbs, toes, and neck.
- Endurance sports (for example, running and triathlon) carry a higher risk of strains from overuse. Common areas for sprains and strains in endurance athletes include hips, calves, hamstrings, quads, and other parts of the legs.
- Those with a history of prior sprains or strains
- People who are overweight
- People who are starting physical activity or exercise programs for the first time
- People with neurologic problems or balance disorders may be at higher risk for strain and sprain injuries from falling.
What Specialists Treat Sprains and Strains?
- A primary care provider, such as a family practitioner, an internist, or a child's pediatrician, may diagnose a sprain or strain.
- You may also see an emergency-medicine specialist in a hospital's emergency department.
- If your strain or sprain is due to an athletic injury, you may see a sports-medicine specialist.
- If the sprain or strain is severe, you may be referred to an orthopedist, a specialist in injuries and disorders of the musculoskeletal system.
- Physical therapists may also be involved in rehabilitation.
How Do Health Care Professionals Diagnose Sprains and Strains?
Most sprains and strains are diagnosed by a history and physical exam. A doctor will examine the joint or muscle group and move them through their normal range of motion, looking for pain, tenderness, weakness, or instability.
If there is a possibility of a bone injury or fracture, an X-ray may be ordered. Magnetic resonance imaging (MRI) is sometimes necessary to determine the exact extent of the injury because strains and sprains occur in soft tissue and do not show up on routine X-rays.
A doctor will determine the severity of a sprain or strain injury by degree or grade.
Degrees/grades of sprains, from mild to severe
- First degree (grade 1, mild): limited pain or swelling to the joint, no instability
- Second degree (grade 2, moderate): moderate pain, swelling, and bruising, and some instability during range of motion
- Third degree (grade 3, severe): severe pain, swelling, and bruising; joint is unstable; ligament is ruptured or torn completely
Degrees/grades of strains, from mild to severe
- First degree (grade 1, low): limited pain, mild tenderness
- Second degree (grade 2, moderate): moderate pain; limited range of motion; swelling and bruising possible
- Third degree (grade 3, high): severe pain, limited or no movement, muscle tissue severely damaged and torn
Are There Treatments and Home Remedies for Sprains and Strains?
Mild sprains and strains can be treated conservatively using home remedies and over-the-counter medications.
The main treatment (first aid) for all sprains and strains is RICE: rest, ice, compression, and elevation. A more severe sprain or strain may require evaluation by a doctor. Joint or extremity splitting or immobilization may be needed. Some severe sprains and strains may require surgery.
Some sprain and strain injuries may require physical therapy rehabilitation to help the tissue heal and to retain and strengthen the muscles and tendons.
For pain, over-the-counter pain relievers may be helpful.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) help reduce pain, inflammation, and swelling (use in children varies; discuss with a pediatrician)
- Acetaminophen (Tylenol)
- Pain-relief creams such as Aspercreme and Biofreeze
There are also some complementary therapies and home remedies that may help reduce inflammation and ease pain. Consult a doctor before using any home remedy, as many have not been scientifically tested or proven effective.
Acupuncture, chiropractic, cupping, and massage are all other treatment modalities that may help someone recover from a sprain or strain injury. Consult a doctor to see if these adjunctive therapies are advised.
What Is the Recovery Time After Treatment of a Sprain or Strain?
- Mild sprains or strains may take two to six weeks for recovery, while severe sprains or strains may take six months to a year to fully heal.
- A grade 1 strain, which is mild, requires two to three weeks of rest for recovery.
- Grade 2 strains are more extensive and usually three to six weeks of recovery time is needed.
- A grade 3 strain is a complete rupture of a muscle and may require surgery to repair, with at least three months of rehabilitation.
- If there are other associated injuries to the bones or surgery is required, healing time and complications will increase.
- Complications of sprains and strains include joint dislocation, pain and recurring swelling, ruptured muscle, or cartilage injuries.
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How Can One Prevent a Sprain or Strain?
It is possible to prevent many sprains and strains from occurring. The American Academy of Orthopaedic Surgeons suggests the following to help reduce one's injury risk:
- Participate in a conditioning program to build muscle strength.
- Do stretching exercises daily.
- Always wear properly fitting shoes.
- Nourish the muscles by eating a well-balanced diet.
- Warm up before any sports activity, including practice.
- Use or wear protective equipment appropriate for that sport.
In addition to the above suggestions, prevent future sprains and strains by
- maintaining a healthy weight;
- wearing proper-fitting shoes, designed for the specific activity;
- keeping household areas safe to prevent falls; and
- not participating in sports or exercise if overly tired or in pain.
What Is Prognosis for Sprains and Strains?
The prognosis of a sprain or strain injury depends on the severity and the site of the injury. Most sprains and strains heal completely with adequate treatment, though there will be a higher risk of reinjuring the same area again.
Reviewed on 4/10/2020
Medically reviewed by Aimee V. HachigianGould, MD; American Board of Orthopaedic Surgery
American Academy of Orthopaedic Surgeons. "Sprained Ankle." February 2016. <http://orthoinfo.aaos.org/topic.cfm?topic=a00150>.
American Academy of Orthopaedic Surgeons. "Sprains and Strains: What's the Difference?" Oct. 2007.<http://orthoinfo.aaos.org/topic.cfm?topic=A00111>.
American Academy of Orthopaedic Surgeons. "Sprains, Strains and Other Soft-Tissue Injuries." July 2015. <http://orthoinfo.aaos.org/topic.cfm?topic=A00111>.
American College of Sports Medicine. "Sprains, Strains and Tears." <http://www.acsm.org/docs/brochures/sprains-strains-and-tears.pdf>.
United States. National Institute of Arthritis and Musculoskeletal and Skin Diseases. "Questions and Answers About Sprains and Strains." July 2012. <http://www.niams.nih.gov/health_info/Sprains_Strains/default.asp>.