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Sprains vs. Strains

By: Dale J. Buchberger, PT, DC, CSCS

The recent stretch of beautiful weather is getting all of us eager to exercise and/or work in the yard. This newfound activity is sure to bring with it a few aches and pains. It may also bring about some minor injuries and unfortunately some severe injuries. Understanding the difference between a minor injury that is treatable at home and a more severe injury that needs professional medical attention can save time, money and pain.

Sprains and strains are common injuries that share similar signs and symptoms. A sprain is a stretching or tearing of a ligament. Ligaments are thick bands of fibrous tissue that connect bone to bone. A strain is a stretching or tearing of muscle or tendon. A tendon is a fibrous cord of tissue that connects muscles to bones. Sprains and strains are graded as first, second and third degree.

First-degree strains and sprains cause very little actual tissue damage, so detecting whether the injury occurred to a tendon or ligament comes down to whether pain is elicited with the contraction of the muscle or not. Generally, the pain will subside in both first-degree sprains and strains in a matter of days. Gradual return to activity is usually possible after a few days with complete return to activity in 1-3 weeks, depending on the area of the body injured and the activity performed.

Second-degree strains can be quite painful if located in the muscle. Pain is often felt with mild contractions of the strained muscle and occasionally at rest. Strains to tendons may not be painful until the muscle contracts forcefully. Second-degree strains in muscles might require professional treatment such as physical therapy to reduce scar tissue formation and assist return of normal function. Second-degree strains to tendons may also require treatment to restore function and prevent progression into a case of tendinitis.

Second-degree sprains may result in laxity or looseness of the joint the ligament supports. Since the ligament is partially torn in a second-degree sprain, the ligament will be unable to resist large amounts of tension. The partial tearing results in bruising, swelling and pain that are usually best treated with rest, ice and compression followed by gradual return to activity. Consultation with a healthcare professional should be obtained to determine whether the amount of ligament damage would slow the recovery. It can take 6-12 weeks for a second-degree sprain to fully heal.

Third degree strains of muscles and tendons are generally a very serious issue and often require surgery. The muscle or tendon ruptures completely. This usually occurs at one end. The end that is torn will retract away from the original attachment site. Some even occur with no pain at all, especially in the case of tendon ruptures. Surgical reattachment of a ruptured or avulsed tendon should occur within 14-21 days of the injury. Therefore, seeking medical attention is imperative to a good long-term outcome. Third degree sprains vary greatly, often depending on which ligament is involved.

Pain, swelling and bruising are usually severe with a complete ligament rupture. While the majority of grade three ligament ruptures require surgical reconstruction there are occasional cases that can be rehabilitated without surgery. Your healthcare provider can let you know if you are a candidate for nonsurgical rehabilitation or if surgery is required. Third degree sprains should also be evaluated by a healthcare professional to give you the best opportunity for an excellent long-term recovery. Remember you should see a doctor if you can’t walk more than four steps without significant pain, you can’t move the affected joint without pain, you have numbness in any part of the injured area, or if the injury is preventing you from getting to sleep or wakes you from a sound sleep.

It is difficult to predict if and when you will incur a sprain or a strain, but we do know that your risk is higher if any of the following factors come into play: You are poorly conditioned; lack of conditioning can leave your muscles weak, inflexible and more likely to sustain injury. Participating through fatigue; fatigued muscles are less likely to provide adequate support for your joints. When you’re tired, you are also less likely to withstand high forces during athletic activities. Failing to warm-up properly; appropriate warm-up before a vigorous physical activity takes longer than you think. For example, proper warm-up for a 5k road race can take 60-90 minutes. The warm-up loosens your muscles, increases joint range of motion, and improves muscle and tendon elasticity making the muscles less prone to trauma and tears.

If rest, ice, compression and elevation do not resolve your pain and restore function within 10-14 days more time is not the answer. Call a healthcare provider you trust and have your injury evaluated.