Sprains and strains

We’ve all had them. Just walking along down the street, minding our own business, then the ankle rolls. All your weight through a small part of a joint that’s meant to handle this movement as a team, it’s all on your little ligament.
Sometimes we manage, we correct and keep walking. No biggie. But sometimes we go down. Hard.
So what do you do when your ankle rolls in, blow up like a balloon and hurts like all hell?

Diagnosis

First, you want to know if this is a sprain, a strain, a contusion or something worse.

Sprain

A sprain refers to an injury of a ligament. Like our example above, this would involve the calcaneofibular ligament but could be any of the surrounding structures.

Sprains are classified by their severity

• Grade 1 (mild) involves some stretching of the ligament fibres
• Grade 2 (moderate) means there are some tears in the ligament. On exam, there might be some looseness on certain movements.
• Grade 3 (severe) means there is a complete tear of a ligament which makes a joint unstable. Often it is hard to use this joint until things have improved. Regardless of the severity, most sprains are painful, have swelling, and bruising and can feel like they throb. Mild sprains do well with RICE therapy (see below), some physical therapy and graded exercises.

Moderate sprains often need a short period of bracing or support.

Severe sprains may need surgical review and repair depending on what was injured and how quick a return to full function is needed.

Strains

A strain is an injury to a muscle or tendon. Tendons are the h2 fibrous bands of tissue that attach muscles to bones. Some common sites of strains are in the foot, leg or back.

Similar to sprains, a strain can be a mild stretching of a muscle or tendon or could be a complete tear. As such the treatment can be similar for mild sprains, but more severe forms of strain need to be accurately diagnosed and managed accordingly.

Contusions

Contusions are caused by damage to muscles that don’t break the skin. Getting hit with a squash ball, jamming your finger in a door, or someone falling on you during a soccer match can all cause contusions.
There is usually swelling and some discolouration, which is blood pooling in the area.
RICE principles apply to minimise further contusions or any secondary inflammatory reactions.
Mild contusions do very well with RICE, however, if there is significant pain please see a doctor for management advice.

Tendonitis

Tendonitis is inflammation or injury to a tendon or the sheath that protects the tendon.
It often occurs from repetitive use that causes small irritations, then an inflammatory response tries to repair this damage. However, if it continues to be used while trying to recover, the inflammatory response can become significant bringing with it pain, swelling, and redness.

Common overuse injuries include the infamous golfers and tennis elbow (seldom caused by golf or tennis mind you), supraspinatus tendonitis, and De Quervain’s syndrome.

But it’s not just overuse that can do it, but not being ready for a particular activity – like trying to run 10km without working up to it or doing heavy weights without warming up. People living in colder climates may experience higher rates of tendonitis if they don’t adequately warm up.

Tendonitis is best treated with rest – as this gives the body a chance to repair that damage. Anti-inflammatory medications may be indicated, or corticosteroid injections can be very helpful. Following these exercises to rehabilitate the area and strengthen any surrounding muscles can hasten recovery and prevent a recurrence.

In severe cases, surgery may be required.

Bursitis

Bursae are like small fluid-filled cushions that are located throughout the body, acting as support between bone, tendon, and muscle, and facilitating friction and movement.

Some important bursae are in the shoulder, outside of the hip bone, on the elbow, in front of the knee, and the heel.

Inflammation of a bursa causes it to swell significantly and become painful. They can feel quite boggy when pressed.

The same measures apply, icing, elevating, use of anti-inflammatory medications, and importantly making alterations to the movement or position that caused it in the first place.

If this doesn’t do the trick, a simple corticosteroid injection into the area from your doctor can quickly relieve the swelling and pain, and at the same time, the extra fluid can be removed.

Sometimes bursae get infected and don’t recover properly. In this situation, an orthopaedic surgeon will remove the bursa whole.

RICE:

We’ve mentioned RICE a few times, and it is a simple acronym to help recover from injury as speedily as possible.

R – Rest

This means ensuring you don’t make the injury worse. If you hurt your shoulder by doing shoulder press, well, we won’t be doing those until things have recovered. Trust us, it’ll hurt to go on anyway.

I – Ice

A cool compression of ice can limit the swelling, by limiting how large the veins can become following an injury. Swelling means to stretch, and it brings with it lots of inflammatory mediators – sometimes too many. Ice won’t stop your recovery; it’ll just make things more comfortable for you.

C – Compression

Like ice, we want to limit how much the injured area swells. A compression bandage like a Tubigrip, or crepe bandage can be used to hold things nice and tight. There are special compression devices for different areas of the body – like tennis elbow.

E – Elevation

Have you noticed how sometimes at the end of the day your feet feel a little swollen and puffy? Well, that’s gravity. It’s why we kick our feet up to relax. If you’ve rolled your ankle, you not only have gravity, but all this inflammation attracting all this fluid to your injury. If you elevate your injured area for as long as possible, it significantly improves pain, recovery and visible swelling. A good rule is to have the injured area above the level of your heart, which is around the mid-chest level.