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February 10, 2012

Sprained Ankle (cont.)

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How are sprains and strains treated?

Rest, ice, compression, and elevation (RICE) are keys elements in the treatment of both sprains and strains.

Depending upon the extent and location of the injury, it may take many weeks to return to normal function. That does not mean that all activity must stop; instead, there needs to be a gradual return to function that is guided by the body's response to activity. Most often, the patient can "listen" to their body's response to activity and increase or decrease the amount and intensity depending upon whether there is pain with the activity or whether there is subsequent pain.

It can be a difficult balance between resting a part of the body enough and resting too much and losing strength and range of motion. For example, when the rotator cuff is strained, it may take a significant amount of time for the shoulder to return to full function. Resting the arm for a prolonged period of time in a sling to rest the muscle group may lead to stiffness in the shoulder joint and loss of range of motion. The health-care professional and patient must appreciate that balance and minimize the loss of function while maximizing the rate of healing.

Muscle, tendon, and ligament heal themselves naturally by repairing the fibers or filling in the damaged area with scar tissue. Full muscle and joint mobility may take time to return and gradual stretching may be required to return the injured area to normal. Additionally, depending upon the area of the body that is injured, the damage sustained, and the amount of loss of function, physical therapy may be suggested. A variety of treatment modalities may be considered, including ultrasound and massage, to encourage healing and preserve range of motion and function.

If the muscle or tendon is ruptured or severely torn (grade 3 strain), surgery may be required to repair the damage. Some common sites of this injury include the

  • quadriceps (front of the thigh) muscle or its tendon, either the quadriceps or patellar, that allows the knee to extend or straighten tendon;


  • Achilles tendon which attached the calf muscle to the calcaneus (heel) and allows the ankle to flex;


  • biceps muscle or tendon which flexes the elbow;


  • hamstring muscle located in the back of the thigh and flexes the knee.

Surgery is a consideration for certain sprains. The decision to offer surgical operations to repair muscle, tendons, or ligaments depends upon the patient's underlying function before the injury and their expectations for activity after recovery. Not all ligaments need repair, even if completely torn. For example, a professional athlete may continue to perform at a high level even with a torn posterior cruciate ligament in the knee but cannot with a torn anterior cruciate ligament.

Anti-inflammatory medications like ibuprofen (Advil) and naproxen (Aleve) are often suggested to help decrease inflammation and relieve pain. Before taking any over-the-counter medication, it is important to appreciate that side effects and medication interactions exist and it is wise to ask your health-care professional or pharmacist for advice and direction.

For more significant pain, prescription pain medications may be prescribed for a short period of time.


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