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What should you know about Strains and Sprains?

If the “PRICE” isn’t right, we may need to call the “POLICE”:  A brief update on the management of acute sprains and strains of soft tissue.

By Dan Krebs BSc MScPT MClSc FCAMPT CGIMS

First off, I want to briefly talk about some terminology with respect to muscle (contractile tissue) and inert (non-contractile) tissue injuries.

Strain

Most commonly refers to injuries involving muscle and includes the muscle pain associated with resistance training called Delayed Onset Muscle Soreness or DOMS all the way to complete ruptures of a muscle.

Sprain

Typically used when referring to ligaments and other non-contractile components of a joint.  These are classified as Primary, Secondary and Tertiary with tertiary being the most severe (or complete rupture).

Now that we have that out of the way, we can discuss management and treatment of these injuries.  


Muscle strains can occur in two ways:

  • From direct contact with an external force ie. Getting hit in the leg during a tackle, or,
  • Via indirect trauma, when the muscle contracts forcefully beyond its capability and causes injury to that muscle ie. soccer players accelerating for a ball and strain a hamstring.

In both cases there can be varying degrees of damage but the basic principles for managing this initial stage remain the same.  However, diagnosis of the injury and its severity should be performed soon after by a qualified health care professional (wink, wink, nudge, nudge – a physiotherapist) and commonly does not require any diagnostic imaging to begin treatment and successfully manage.  

In the first 2-3 days after injury, it is important to Protect the muscle by limiting its use as it is important for scar tissue to form a bridge between the torn strands of muscle fibres.  This stage also involves Icing the affected area to decrease swelling as well as helping with pain managementCompression with a tensor bandage or sleeve is also meant to limit swelling and improve transition to the healing phase and finally Elevation of the area to decrease pooling of fluid in the area.  

So far we have the ‘PICE’, but one more critical component is required to optimize tissue healing and increase people's durable return to activity and that is Optimal Loading.  Optimal loading refers to the time and force sensitive loading of the affected tissue which can improve the tensile durability of the scar bridge that forms between the torn fibres.  

This portion of the ‘POLICE’ acronym is where the expertise and training of a registered physiotherapist (at Panther Sports Medicine) can play an important role in those acute muscle strains.


Now we will move onto the sprain side of things and give an example of management.  Like I mentioned earlier, the term sprain commonly refers to ligaments or tissue other than muscle.  Ligaments add structural integrity to joints, giving them stability and keeping the joints surfaces in approximation.  

Sprains to joints can occur through:

  • Direct trauma ie. Being tackled at the knees, and/or,
  • Indirectly by placing large amount of stress on the joint beyond what the ligament can withstand ie. Trying to perform a sharp pivot turn.

As with strains, sprains require similar management with potentially more emphasis on Protection.  Because ligaments can aid in the structural integrity of joints it is very important to brace the injured joint and restrict its range of motion to allow adequate scar tissue to form.  Injuries to the Medial Collateral Ligament (MCL) of the knee are now treated with a special knee brace rather than surgical intervention.  Depending on the severity of injury, bracing (protection) may be required for a few days up to 3-6 weeks.

As with strains, sprains require similar management with potentially more emphasis on Protection.

Because ligaments can aid in the structural integrity of joints it is very important to brace the injured joint and restrict its range of motion to allow adequate scar tissue to form.  

Injuries to the Medial Collateral Ligament (MCL) of the knee are now treated with a special knee brace rather than surgical intervention.  Depending on the severity of the injury, bracing (protection) may be required for a few days up to 3-6 weeks.

Again, it is important to have these injuries evaluated by a physiotherapist who can determine the appropriate course of treatment.  

An important note for those with acute knee or shoulder injuries in Calgary, Panther Sports Medicine collaborates with Sport Medicine doctors and Orthopaedic Surgeons at the Knee and Shoulder Clinic which is run out of the Oakridge location (Phone # 403-258-2659) and may be able to expedite those that require further medical management.


References:

1. Duffy P. Miyamoto R.  Management of medial collateral ligament injuries in the knee: An update and review.  Phys Sportsmed.  2010.  38(2): 48-52.

2. Jarvinen T A H. Jarvinen T L N. et al.  Muscle injuries: optimising  recovery.  Best Pract Res Clin Rheumatol. 2007. 21(2):317-331

3.Maffulli N. Del Buono A. et al. Muscle Injuries: A brief guide to classification and management. Translational Medicine. 2015. 12(4): 14-18.

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