Strains and sprains

Key points about strains and sprains

  • Muscle strains and ligament sprains are two common injuries that cause various degrees of pain and swelling.
  • These injuries respond well to rest, ice, compression, elevation and referral (R.I.C.E.R). This is effective treatment for the first 2–3 days after the injury. It helps protect the injured area and promote a full recovery.
  • If at any time you are worried an injury might be severe, or the pain, swelling or function gets worse and doesn't improve within 2 days, visit your healthcare provider to have it checked.
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Strains – muscle or tendon

A strain occurs when a muscle or tendon (a strong tissue that connects muscle to bone), is overstretched or torn. Strains are usually caused by putting stress on tight or weak muscles. For example, if you have not warmed up enough before explosive stop-start exercise or if your muscles become tired and you overstrain during exercise.

If a strain isn't allowed to heal properly, or if scar tissue forms, the muscle or tendon can remain weak or painful.

Sprains – ligament

A sprain is a tear in a ligament (a tough fibrous cord that connects a bone to another bone). Sprains are caused by the sudden, forceful twisting of a joint. The extent of the injury will depend on how badly the ligaments are torn or stretched:

  • Mild sprain: ligaments are only slightly stretched or torn.
  • Moderate sprain: ligaments are partly torn.
  • Severe sprain: ligaments are completely torn.

If a sprain is not allowed to heal properly, there is a good chance the same injury will recur.

Commons signs and symptoms of strains and sprains include the following:

  • Pain, tenderness and limited movement. This is your body’s way of preventing you from further injury.
  • Swelling and inflammation. 
  • There might also be some bleeding inside the tissue, which may reveal itself later as a bruise.

Some sites are more at risk of strains and sprains than others. The commonly affected sites and injuries are discussed below:

Site  Cause of injury
  • Ankle injuries are the most common of joint injuries.
  • The most common ankle sprain is when the sole of the foot is turned inwards, injuring the ligaments on the outside of the ankle. This is known as an 'inversion sprain'.
  • Any ankle sprain can put you at risk for another since, when it heals, it leaves the ligament weakened and less flexible for some time.   
  • Tearing the anterior cruciate ligament (ACL), which joins bones at the knee, is a common sports injury.
  • It can happen when the knee is suddenly twisted with force.
  • This is a serious injury that needs prompt medical attention by a doctor.
  • It may require surgery as well as physical rehabilitation.
Hamstring and calf muscle
  • The hamstring and calf muscles in the back of the leg are easily torn during sprints or jumps, especially if you have not warmed up properly first.
  • There will be pain, swelling, and bleeding in the muscle (bruising).
  • It is important that the muscle heals completely and is at full strength before returning to exercise.
  • Supervised exercises and physiotherapy will help.    
  • If not treated properly, scar tissue can form leaving a weak spot and making future injury likely.

The main aims of treatment are to keep the inflammation and swelling to a minimum, and to be able to use the joint normally again. Most strain and sprain injuries respond well to first aid treatment which involves using R.I.C.E.R: rest, ice, compression, elevation and referral. 


Image credit: Healthify He Puna Waiora, NZ

R.I.C.E.R. stands for:

Rest: Stop the activity as soon as you have become injured. Try not to move or load the injured part. Total rest helps prevent further damage.

Ice: Apply ice or a bag of frozen veggies wrapped in a towel to the injury for 20 minutes as soon as possible after the injury. This should be repeated once every two hours over the next two days. Cold will reduce the pain, bleeding and swelling around the injury.

Compression: A firmly applied elasticated bandage will also reduce pain, bleeding and swelling. If there is any numbness or tingling in the fingers or toes, loosen the bandage.

Elevation: Raise the injured part above the level of your heart if possible, resting it on a chair or cushion. This will help reduce bleeding and swelling.

Referral: Within the first two days, if the swelling and pain have not eased and you are unable to use that joint, it is important you visit a doctor to have the injury checked and to get a precise diagnosis. It could be a broken bone or an additional injury to the sprain/strain. Further tests, treatment and physical rehabilitation may need to begin right away.

In addition, avoid HARM for the first 72 hours: 

Heat: Avoid heat such as hot packs or baths. Heat can increase the bleeding at the injury.
Alcohol: Avoid alcohol as it can increase bleeding and swelling and you may have less awareness of pain at the site of the injury.
Running (or any exercise): Running and exercise in the early stages could do more damage so should be avoided.
Massage: Massage in the first 72 hours (3 days) may increase bleeding and swelling and should be avoided. 

You can take over-the-counter pain relievers (analgesics) to treat moderate muscular pain and joint pain. If you are not seeing your doctor immediately, ask your pharmacist for advice about the best type of pain relief for your particular injury. If required, your doctor or other prescriber can prescribe stronger medications for more severe pain.

Once the pain starts to go away, rehabilitation guided by a doctor or physiotherapist may be needed to gain a full recovery. This may include exercises to:

  • restore normal movement and flexibility
  • improve strength
  • restore coordination and control
  • improve balance
  • maintain overall fitness/healthy body weight
  • rebuild confidence.

A physiotherapist may also use other treatments (eg, massage and ultrasound) to assist recovery. It is important, however, to make a 100% recovery before fully straining or testing the injured part in your activity or sport. Your doctor or physiotherapist will advise when you can do this, you may need to slowly return to sports and other activities.

The following are useful tips on how to avoid injury:

  • Improve general strength and fitness to protect joints.
  • Improve specific sports skills and technique.
  • Correct any muscle strength imbalances.
  • Always do a gradual warm-up/jog before exercise.
  • Follow any specific advice given by your physiotherapist or doctor.
  • Stop if you feel any pain. 

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Lizzy Guest, Academic Staff member in Health/Physiotherapist, Te Pukenga/Toi Ohomai.

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