Ankle Sprains, Knee Strains, Wrist Pains: Oh Boy!

A sprain results from a sudden twist, fall or a blow to the body that forces a joint out of its normal position. This force causes an overstretch or tear of the ligament and supporting joint. Routinely, sprains occur when people fall and land on an outstretched arm, slide into a base, land on the side of their foot, or twist a knee with the foot planted firmly on the ground.

Although sprains can occur in both the upper and lower parts of the body, the most common site is the ankle. Ankle sprains are the most common injury in the United States and most occur during sports or recreational activity. Approximately 2 million ankle injuries occur each year, and a whopping 90% are classified as an ankle sprain.

The talus bone and the ends of the two of the lower leg bones, the tibia and the fibula, form the ankle joint. This joint is supported by several lateral, or outside, ligaments and medial, or inside, ligaments. Most ankle sprains happen when the foot turns inward as a person runs, turns, falls or lands on the ankle after a jump. This type of sprain is referred to as an inversion injury. One or more of the lateral ligaments are injured, typically the anterior talofibular ligament. The calcaneofibular ligament is the second and more frequently torn ligament.

The knee is another common site for a sprain. A blow to the knee or a fall is most often the culprit, as sudden twisting results in a sprain. Sprains can also occur frequently at the wrist, usually when people fall and land on an outstretched hand. Symptoms and signs of sprains include swelling, bruising, pain, and functional ability, which is loss of the ability to move and use the joint. However, these signs and symptoms vary in intensity, depending on the severity of the sprain. Sometimes people feel a pop or tear when the injury first occurs.

In general a grade I or mild sprain causes over-stretching or slight tearing of the ligament with no joint instability. A person with a mild sprain experiences minimal pain, swelling and little to no loss of functional ability. Bruising is absent or slight and the person should be able to put weight on the affected joint..

A grade II or moderate sprain will cause partial tearing of the ligament and is characterized by moderate pain, swelling and bruising. A person with a moderate sprain will have some difficulty placing weight on the affected joint and will experience some loss of functional ability. An MRI is recommended and will differentiate between a significant partial injury and a complete tear in the ligament.

Those individuals who sustain a grade III or severe sprain completely tear or rupture the ligament. Pain, swelling and bruising are severe and the joint is unable to bear weight.  

Signs that a sprain or injury to the ankle is serious includes severe pain and the inability to place weight on the injured joint. The area over the ankle will also be tender to the touch as significant swelling will be present. The injured area may also have lumps or bumps, the joint will not move without pain and there will be numbness and or redness.

Conversely, a strain is caused by pulling or twisting a muscle or tendon, strains can be acute or chronic. An acute strain is caused by trauma or an injury such as blow to the body; it can also be caused by improperly lifting heavy objects or over-stressing muscles. Chronic strains are the result of overuse, prolonged, repetitive movement of the muscles and tendons. Two common sites for a strain are the back and the hamstring. Contact sports such as football, hockey, soccer, wrestling and boxing put people at risk for strains. Tennis, golf, gymnastics, rowing and other sports that require extensive gripping can increase the risk of hand and forearm strains. Elbow strains sometimes occur in people who participate in racquet sports and throwing and contact sports.

Typically, people with a strain experience muscle spasms, weakness and pain. Localized cramping, inflammation and are also common indicators with a minor or moderate strain, expect some loss of muscle function as well. Pain within the injured area and general weakness of the muscle is natural after any injury. Severe strains that partially or completely tear the muscle or tendon are often extremely painful and disabling. Treatment for sprains and strains is similar and can be thought of as having two stages. The goal during the first stage is to reduce swelling and pain, which includes RICE therapy and NSAIDs may also be recommended to reduce pain and inflammation.

RICE therapy requires immediate reduction of exercise and activities if the joint is not weight-bearing like the ankle or knee. A walking aid will help an ankle injury relieve weight on the injured joint. Apply an cold ice or gel pack to the injured area for 20 minutes at a time, 4 to 8 times a day. To avoid frostbite, do not apply cold therapy for more than 20 minutes at a time. Compression of an injured ankle, knee or wrist will help reduce swelling. Elastic wraps, foot and ankle braces, and splints can be used. Keep the injured ankle, knee, elbow or wrist elevated, above the level of the heart to help decrease swelling after injury occurs.

For people with a moderate or severe sprain, particularly of the ankle, a hard cast or walking boot maybe required. Severe sprains and strains will likely need surgery to repair torn ligaments, muscle and or tendons. It’s important that moderate and severe sprains and strains be evaluated by a practitioner to determine an appropriate treatment plan.

The second stage of treating a sprain or strain is rehabilitation, whose overall goal is to improve the condition of the injured part and restore its function. An exercise program designed to prevent stiffness, improve range of motion and restore the joint’s normal flexibility and strength must be followed to expedite healing, restore joint function and strengthen the injured area to prevent reoccurrence.

When acute pain and swelling diminishes, daily exercise therapy, several times a day, should be maintained until full health is restored. This is important to reduce swelling, prevent stiffness and restore normal, pain-free range of motion. Another goal of rehabilitation is to increase strength and regain flexibility. This process begins in week 2 of therapy after the injury.

The final goal is the return to full daily activities, including sports when appropriate. Returning to full activity before regaining normal range of motion, flexibility and strength increases the chance of re-injury and may lead to a chronic problem.

The amount of rehabilitation and time needed for full recovery after a sprain or strain depends on the severity of the injury and individual healing rates. A moderate ankle sprain, for example, may require 3 to 6 weeks of rehabilitation before a person can return to full activity. With a severe sprain, it could take up to 8 to 12 months before the ligament is fully healed.

To prevent sprains and strains maintain a healthy, well-balanced diet to keep muscles strong and stable. Practice safety measures to help prevent falls. Wear shoes that fit properly and replace athletic footwear as soon as the tread wears out or the heel wears down on one side. Stretch daily, and make sure to warm-up. Finally, wear protective equipment like an ankle brace or padding, run on even surfaces when possible and avoid exercise or playing sports when fatigued or in pain.