PT Tip of the Month Archive

Strain and Sprains

By definition a strain is any overstretching, overexertion, and/or overuse of muscles and their connecting tendons. A tendon is a band of connective tissue that is located at the ends of a muscle and connects the muscle to a bone (see figure 1). To perform motion, a muscle will contract and put a pulling force through the tendon, which then moves the joint. A musculotendious unit that is commonly strained are the wrist extensor muscles, which originates in the elbow and terminates in the wrist and hand. The function of this muscle is to create wrist extension and aid on gripping activities. It is commonly strained during activities in which we repetitively utilize the muscle, such as typing on a keyboard and gripping tools, which put too much stress through the common extensor tendon. This condition is commonly referred to as Tennis Elbow or Lateral epicondylitis. For a more thorough description of Tennis Elbow, see our Tennis Elbow tip of the month.

Similarly, a sprain is severe stress, stretch and/or tear of a ligament. A ligament is a broad band of connective tissue that connects one bone to another bone (see figure 2). It provides static stability for a joint, by limiting the amount of movement and direction of movements within a joint. A ligament that is commonly sprained is the anterior talofibular ligament (ATF) in the ankle. The ATF ligament provides stability on the outside of the ankle and limits the ankle from rolling in. When too much stress is forced through the ATF ligament, it will overstretch and a sprain occurs. For a more thorough description of ankle sprains, see our Ankle sprain tip of the month.

Treatment

The initial treatment for an acute sprain or strain is similar in nature for each. The principle of PRICE, which stands for Protect, Rest, ICE, COMPRESS, and Elevate (see figure 3); will help to alleviated pain and swelling around the tendon or ligament. Focus should be on avoiding all movements that increase pain and relying on movements which are less painful in nature. In most cases, an acute sprain can be protected with a brace or compression sleeve to limit motion through the joint. Also assistive devices such as axillary crutches or a cane can be used to rest lower extremity sprains and strains. As the pain and swelling resolve, care should focus on increasing range of motion, strength, joint mobility and stability, within a pain-free or minimally painful range.

To avoid initial injury or reinjury

Understanding the mechanism of injury or cause of injury can be very helpful when trying to avoid re-injury. In the case of the ankle sprain, exercises should be performed to increase strength, range of motion and dynamic stability or balance, which will help the ankle compensate and control strenuous motions, that would previously caused injury. In the case of tennis elbow, focus must be made on increasing strength, range of motion as well as investigating factors which led to the injury. This can include an ergonomic assessment of your work or desk space (see Ergonomic tip of the month). Understanding how the injury occurred, whether from bio-mechanical faults and/or unfriendly ergonomic situations, will allow for the most success recovery and avoidance of re-injury. Without treatment through medical care and/or with physical therapy, conditions such as strain and sprains can progress to more serious issues, such as complete tears and tendonitis The best mode of treatment is to treat the issue early without ignoring the symptoms.

If you feel that you have experienced a sprain and/or strain and would like to schedule a Physical Therapy evaluation, please call 617.232.7246(PAIN) for our Brookline office or 617.325.7246(PAIN) for our West Roxbury office.

33 Pond Avenue, Suite 107B Brookline, MA 02445 Tel: (617) 232-PAIN (7246) Fax: (617) 232-5196
1208B VFW Parkway, Suite 202 West Roxbury, MA 02132 Tel: (617) 325-PAIN (7246) Fax: (617) 325-7282