Muscle Sprains and Strains (cont.)

What causes a strain?

A strain is caused by twisting or pulling a muscle or tendon. Strains can be acute or chronic. An acute strain is caused by trauma or an injury such as a blow to the body; it can also be caused by improperly lifting heavy objects or over-stressing the muscles. Chronic strains are usually the result of overuse--prolonged, repetitive movement of the muscles and tendons.

Where do strains usually occur?

Two common sites for a strain are the back and the hamstring muscle (located in the back of the thigh). Contact sports such as soccer, football, hockey, boxing, and wrestling put people at risk for strains. Gymnastics, tennis, rowing, golf, 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, throwing, and contact sports.

What are the signs and symptoms of a strain?

Typically, people with a strain experience pain, muscle spasm, and muscle weakness. They can also have localized swelling, cramping, or inflammation and, with a minor or moderate strain, usually some loss of muscle function. Patients typically have pain in the injured area and general weakness of the muscle when they attempt to move it. Severe strains that partially or completely tear the muscle or tendon are often very painful and disabling.

How are sprains and strains treated?

Reduce Swelling and Pain

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. At this stage, doctors usually advise patients to follow a formula of rest, ice, compression, and elevation (RICE) for the first 24 to 48 hours after the injury. The doctor may also recommend an over-the-counter or prescription nonsteroidal anti-inflammatory drug, such as aspirin or ibuprofen, to help decrease pain and inflammation.

For people with a moderate or severe sprain, particularly of the ankle, a hard cast may be applied. Severe sprains and strains may require surgery to repair the torn ligaments, muscle, or tendons. Surgery is usually performed by an orthopaedic surgeon.

It is important that moderate and severe sprains and strains be evaluated by a doctor to allow prompt, appropriate treatment to begin. The information above lists some signs that should alert people to consult their doctor. However, a person who has any concerns about the seriousness of a sprain or strain should always contact a doctor for advice.

Begin Rehabilitation

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. The health care provider will prescribe an exercise program designed to prevent stiffness, improve range of motion, and restore the joint's normal flexibility and strength. Some patients may need physical therapy during this stage.

When the acute pain and swelling have diminished, the health care provider or physical therapist will instruct the patient to do a series of exercises several times a day. These are very important because they help reduce swelling, prevent stiffness, and restore normal, pain-free range of motion. The health care provider can recommend many different types of exercises, depending on the injury. For example, people with an ankle sprain may be told to rest their heel on the floor and write the alphabet in the air with their big toe. A patient with an injured knee or foot will work on weight-bearing and balancing exercises. The duration of the program depends on the extent of the injury, but the regimen commonly lasts for several weeks.

Another goal of rehabilitation is to increase strength and regain flexibility. Depending on the patient's rate of recovery, this process begins about the second week after the injury. The health care provider or physical therapist will instruct the patient to do a series of exercises designed to meet these goals. During this phase of rehabilitation, patients progress to more demanding exercises as pain decreases and function improves.

The final goal is the return to full daily activities, including sports when appropriate. Patients must work closely with their health care provider or physical therapist to determine their readiness to return to full activity. Sometimes people are tempted to resume full activity or play sports despite pain or muscle soreness. 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 the time needed for full recovery after a sprain or strain depend on the severity of the injury and individual rates of healing. For example, a moderate ankle sprain may require 3 to 6 weeks of rehabilitation before a person can return to full activity. With a severe sprain, it can take 8 to 12 months before the ligament is fully healed. Extra care should be taken to avoid re-injury.


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