Pain can be a great communicator when it comes to telling you that you have suffered a strain, a sprain or a broken bone.
It might not be so hot in providing specifics of your injury, however. Most often, that is where a provider comes in and delivers what you need, whether that’s information or treatment or both.
Broken bones and fractures are the same thing. Let’s start there.
For more complex matters regarding these kinds of injuries, Anthony Kasch, M.D., an orthopedic surgeon at Sanford Orthopedics and Sports Medicine in Bismarck, North Dakota, can help us.
He treats a variety of injuries that include broken bones, tears, and strains/sprains of muscles, tendons and ligaments and is equipped with the diagnostic tools and expertise to give you insight into your injury.
Pain tells you where it hurts. Dr. Kasch can tell you why it hurts and how you can fix it.
We asked Dr. Kasch to help explain some of the basics of these common but often painful injuries.
What is a sprain?
By definition, a sprain is a stretch or tear in a ligament. A ligament is the tissue that connects your bones and stabilizes and supports your body’s joints. For example, ligaments connect your lower leg to your upper leg.
In a mild sprain, a ligament is stretched, but the joint remains stable and is not loosened. A moderate sprain partially tears the ligament, causing the joint to be unstable.
With a severe sprain, ligaments tear completely or separate from the bone. This loosening interferes with how the joint functions. You may feel a tear or pop in the joint. Although the intensity varies, all sprains commonly cause pain, swelling, bruising, and inflammation.
The ankle is the most commonly sprained joint and is more likely if you’ve had a previous sprain there. Repeated sprains can lead to ankle arthritis, a loose ankle, or tendon injury.
What is a strain?
A strain is a twist, pull or tear of a muscle – and sometimes a tendon. Tendons are cords of tissue that connect muscles to bones.
Acute strains are caused by stretching or pulling a muscle or tendon. Chronic strains are the result of overuse of muscles and tendons through prolonged, repetitive movement. Not getting enough rest during intense training can cause a strain.
Typical symptoms of a strain include:
- Pain
- Muscle spasm
- Muscle weakness
- Swelling
- Inflammation
- Cramping
In severe strains, the muscle, tendon, or both are partially or completely ruptured, resulting in serious injury. Some muscle function will be lost with a moderate strain, in which the muscle, tendon, or both are overstretched and slightly torn. With a mild strain, the muscle or tendon is stretched or pulled slightly.
“Outside of an X-ray, MRI or other advanced imaging, there is often not a lot a patient can do outside of seeing a qualified health care provider,” Dr. Kasch said. “If somebody has a pain in their leg, for instance, it could be a stress fracture or it could be a strain or a sprain. It can be very hard to tell without a provider looking at it.”
How does treatment vary for a broken bone, a strain or a sprain?
Depending on severity, any of these injuries could involve a period of immobilization, physical therapy, surgery, or a combination of all of them. In general, mild sprains and strains may heal more quickly and completely with rehab exercises and a change in physical routine during recovery, whereas a more severe injury is more likely to require surgery.
“In a general sense, treatment can often be the same,” Dr. Kasch said. “It can really depend on where a fracture happens on your body. If it’s a tiny non-displaced fracture in your ankle, a lot of times if you immobilize it for a bit and then begin progressively working on your motion and strength, you can resume regular activities more quickly.
“A lot of times with strains and sprains that are not severe, you can actually walk and do some gentle stretching and strengthening exercises that will help you progress quickly.”
Bone breaks should always be looked at by a health care provider. Breaks can heal incorrectly if ignored.
“If it’s serious you should call an ambulance,” Dr. Kasch said. “If it’s not to the point where you think you need that, you can immobilize it or support it in some way and then contact a provider.”
What can you do right away for a strain or sprain?
Rest, ice, compression, and elevation (called RICE) usually will help reduce damage caused by sprains and strains. Start RICE right away after the injury.
RICE relieves pain, limits swelling, and speeds healing. It’s often the best treatment for soft-tissue injuries, like sprains and strains. Here’s what to do:
- Move the injured area as little as possible to allow healing to begin.
- Apply ice right away to reduce inflammation, which causes more pain and slows healing. Cover the injured area with an ice pack wrapped in a thin towel for about 15 to 20 minutes, three to four times a day.
- Using a pressure bandage helps prevent or reduce swelling. Use an elastic bandage and wrap the injured area without making it so tight that it will cut off the blood supply.
- Raise the injured area above the level of the heart. Prop up a leg or arm while resting it. You may need to lie down to get your leg above your heart level.
Do all four parts of the RICE treatment at the same time.
If you think you have a more serious injury, like a broken bone, call your health care provider or go to the emergency department right away.
Have treatments for these kinds of injuries changed over the years?
“We’ve gotten much better at diagnosing and treating injuries over the past few decades,” Dr. Kasch said. “In many cases we are letting people work on their motion and strengthening much earlier than we used to. One example is that even as recent as the ’90s and early 2000s, we would often immobilize patients’ procedures such as ACL (anterior cruciate ligament) surgery because we thought it would allow for better healing. We now know that could lead to a lot of things, such as severe stiffness, that could be a real detriment to someone’s ability to get back to playing sports.”
A torn ACL now might include therapy to get your knee moving within a few days of surgery.
“We’re better at telling people what they can and can’t do at various stages in the healing process,” Dr. Kasch said. “Back then you might hear that because it’s a fracture you’re not going to move it for 6-12 weeks. We now know that degree of immobilization could lead to a lot of unintended consequences.”
Do you have any advice for those who suffer these injuries?
“We see a lot of people who have put things off too long,” Dr. Kasch said. “Maybe they’re trying to be tough and keep walking on an injury or playing sports and the next thing you know it’s six months or a year down the road and it’s not getting better.”
Patients then discover after the fact that the healing process will be more difficult than it would have been had they addressed the injury soon after it happened.
“I’m a big fan of coming in and at least having someone qualified look at it,” Dr. Kasch said. “There are a lot of injuries we can treat fairly easily early on, but if it has been six months or a year and the injury has gotten worse, sometimes our effective treatment options become limited. Don’t be afraid to come in and at least get your injury looked at.”
Learn more
- Emergency vs urgent care: The ER isn’t for everything
- Advice from a podiatrist: Match your shoes to the occasion
- Understanding and treating ACL injuries
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Posted In Bismarck, Emergency Medicine, Orthopedics, Sports Medicine
