Sprains and strains often result from sports or exercise, but can easily result from any physical activity. Sprains result from an injury to a ligament (the connective tissue that links bones together at joints), most often in the ankle, knee, elbow, or wrist. Strains are tears in muscle tissue, commonly occurring in the muscles that support the neck, thigh, groin, and ankle.
Signs and Symptoms
Sprains and strains cause pain and swelling. You may have joint instability or disability if the injury is serious, involving a muscle or ligament tear.What Causes It?
Sprains generally result from a twisting force applied to a joint while it is bearing weight, which causes the ligament to stretch beyond its natural limit. Muscle strains occur when the weight load on a muscle is greater than what the weakest part of the muscle can bear. Strains usually occur during activities that require a muscle to be stretched and bear weight at the same time. You are at risk for a sprain or strain if you do the following.- Exercise without warming up properly
- Use athletic equipment that does not fit properly
- Participate in sports and activities that you are not conditioned for
What to Expect at Your Provider's Office
Your health care provider may take an X ray. If your injury is severe, he or she may also order an MRI. You may need to have the injured limb wrapped in an elastic bandage or put in a soft cast.Treatment Options
Your health care provider will recommend that you treat the injury with RICE: rest, ice (wrapped in a cloth or a towel—do not apply ice directly to the skin), compression, and elevation of the affected area. Apply RICE as needed over the first several days following the injury.Ice reduces pain, bleeding, and inflammation. It may also reduce secondary damage to other parts of the joint. However, the overall clinical benefit is not known. Bleeding and inflammation may play an important role in the healing process. Wrap the affected area in elastic bandage in more severe cases. Cast may be required to stabilize injuries.
Activity that involves the affected area should be limited for an average of seven days.
Drug Therapies
Over-the-counter pain relievers (analgesics) and anti-inflammatory agents usually help; however, it is important to consult your physician for adequate dosing. When injuries are more severe or chronic, however, continued use of analgesics may lead to aggravation of the condition. Analgesics should not be used to mask pain so that activity can be resumed without proper immobilization.- Aspirin—325 mg, 1 to 2 tablets every four hours
- Naproxin—210 mg, 2 to 3 tablets every 8 to 12 hours
- Ibuprofen—200 mg, 2 to 3 tablets every 4 to 6 hours
- Analgesic balms
- Acetaminophen—325 mg, 1 to 2 tablets every 4 hours
Complementary and Alternative Therapies
Specific nutrients and herbs may help restore the integrity of connective tissue, reduce swelling, and provide pain relief.Nutrition
- Vitamin C (250 to 500 mg two times a day) to reduce swelling and support connective tissue.
- Bromelain (250 to 500 mg three times a day between meals) helps reduce swelling.
- Beta-carotene (50,000 IU per day) is needed to make collagen.
- Zinc (15 to 30 mg per day) helps you heal faster.
- Vitamin E (400 IU/day) has antioxidant effects.
- Adequate protein intake is important.
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.
Flavonoids are found in dark berries and some plants. They help reduce swelling and strengthen the tissues that are affected by sprains and strains. The following may be taken in dried extract form as noted.
- Quercetin: 250 to 500 mg three times a day
- Hawthorn (Crataegus monogyna): 500 mg three times a day
- Turmeric (Curcuma longa) makes the effect of bromelain stronger. Take 250 to 500 mg each of turmeric and bromelain, three times a day between meals.
Homeopathy
There have been few studies examining the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for sprains and strains based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
- Arnica (topical) — this remedy is generally considered the first choice homeopathic treatment for acute injury; it is applied topically in addition to an appropriate internal remedy; it should not to be used, however, if skin the has open cuts over the injured area
- Arnica (internal) — for injuries with swelling, bruising, and inflammation; individuals should switch to another appropriate remedy once swelling has subsided
- Bryonia — for swollen injuries that are worsened with movement; this remedy is especially useful for chest, shoulder, and hamstring injuries; often used if Arnica or Rhus toxicodendron fails
- Ledum — for sprained ankles that feel cold or numb but improve with cold applications (such as ice) and worsen with warm applications
- Rhus toxicodendron — this remedy is used after the initial symptoms of an injury have improved (such as from using Arnica); for pain during initial movement that subsides with more movement; affected area generally feels hot; this remedy is especially appropriate for lifting or overexertion injuries
- Ruta — for tendonitis, torn ligaments and other injuries that feel hot to the touch; especially useful as a treatment for overexertion such as with tennis elbow and runner's knee; symptoms tend to be worse with initial movement, but continued motion does not bring relief
Castor oil pack. Apply oil directly to skin, cover with a clean soft cloth and plastic wrap. Place a heat source over the pack and let sit for 30 to 60 minutes. For best results, use for three consecutive days.
Acupuncture
Acupuncture appears to be effective for sprains and strains. One study of 20 people found that acupuncture improved feelings of soreness. Acupuncturists often apply moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) in combination with needling in order to strengthen or deepen the treatment for this condition.
Chiropractic
Chiropractors commonly treat sprain and strain injuries, particularly those that involve pain and diminished function. In fact, a significant number of people who visit chiropractors do so for sprain and strain injuries. In addition to joint manipulation, applications of ice and heat, the use of ultrasound or electrical muscle stimulation are some of the ways chiropractors treat sprains and strains. Stretching and strengthening exercises are also often recommended to aid recovery and rehabilitation.
In a study of individuals with ankle sprains, researchers compared the effectiveness of chiropractic joint manipulation with an anti-inflammatory medication. They found that joint manipulation was as effective as the anti-inflammatory medication in improving pain and flexibility, but it was more effective than the medication in improving range of motion.
Massage
Therapeutic massage is effective at increasing circulation and may relieve spasm in surrounding muscle groups.
Following Up
Your health care provider probably won't need to see you again unless your injury was severe or you have complications.Special Considerations
Be careful of recurring sprains and strains. Once a muscle or tendon is injured, it is susceptible to reinjury, especially if you return to full activity too soon. Sprains and strains are easy to prevent. Basic physical fitness and strength training with proper warm-up and cool-down reduce the stress to muscles and joints.References
Balch JF, Balch PA. Prescription for Nutritional Healing. Garden City Park, NY: Avery Publishing Group; 1997.
Baclofen. NMIHI. Accessed at http://www.nmihi.com/b/baclofen.html on March 3, 2018.
Birrer RB, ed. Sports Medicine for the Primary Care Physician. Boca Raton, Fla: CRC Press; 1994.
Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:429.
Brown DJ. Herbal Prescriptions for Better Health. Rocklin, Calif: Prima Health; 1996.
Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.
Coetzer D, Brantingham J, Nook B. The relative effectiveness of piroxicam compared to manipulation in the treatment of acute grades 1 and 2 inversion ankle sprains. Journal of the Neuromusculoskeletal System. 2001;9(1):1-12.
Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 286-287.
First Aid: Strains and Sprains. The Nemours Foundation. Accessed at https://kidshealth.org/ on March 3, 2018.
JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.
Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.
Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 138-139.
Ibuprofen. NMIHI. Accessed at http://www.nmihi.com/i/ibuprofen.html on March 3, 2018.
Kibler WB, Herring S, Press J, Lee P. Functional Rehabilitation of Sports and Musculoskeletal Injuries. Gaithersburg, Md: Aspen Publishers; 1998.
Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.
Lin JG, Yang SH. Effects of acupuncture on exercise-induced muscle soreness and serum creatine kinase activity. Amer J Chin Med. 1999;27(3-4):299-305.
Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:38, 326, 330.
Naproxen. NMIHI. Accessed at http://www.nmihi.com/n/naproxen.html on March 3, 2018.
Null G. The Clinician's Handbook of Natural Healing. New York, NY: Kensington Publishing Corp; 1997.
Nyiendo J, Lamm L. Disabling low back Oregon workers' compensation claims. Part I: Methodology and clinical categorization of chiropractic and medical cases. J Manipulative Physiol Ther. 1991;14(3):177-184.
Olshevsky M, Noy S, Zwang M, Burger R. Manual of Natural Therapy. New York, NY: Facts on File; 1989.
Sprains and Strains. MedlinePlus. Accessed at https://medlineplus.gov/ on March 3, 2018.
Sprains and strains Disease Reference Guide. Drugs.com. Accessed at https://www.drugs.com/ on March 3, 2018.
Sprains. Symptoms and causes. MFMER. Accessed at https://www.mayoclinic.org/ on March 3, 2018.
Strauss RH, ed. Sports Medicine. Philadelphia, Pa: WB Saunders Co; 1991.
Vardenafil. NMIHI. Accessed at http://www.nmihi.com/u/vardenafil.html on March 3, 2018.
Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 126-127.
Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 335.
Zachazewski JE, Magee DJ, Quillen WS. Athletic Injuries and Rehabilitation. Philadelphia, Pa: WB Saunders Co; 1996.