What is a Sprain?


For some of us, summer means outdoor sports, camping, family hikes, the beach, swimming etc.  Sometimes in these moments of enjoyment, an injury can happen.

One common injury is a sprain. A sprain involves a overstretching, or tear to the ligaments of a joint.  A ligament is a group of fibers connecting one bone to another, helping to passively stabilize the joint and provide your brain with information of where the joint is in space (proprioception). How many directions a ligament stabilizes, and how much force it can endure  depends on where the ligament attachments are, and which joint the ligament is protecting.
Some common sprains are in the ankle, knee and wrist due to falls, missteps, or traumas.
A variety of factors, such as the degree of force, the angle and velocity of the trauma, and strength of ligament can affect the degree of injury. There are III classifications of sprains:

lig sprain gradesI- overstretching of a few fibers of the ligament
II-partial tear of the ligament, usually associate with moderate bruising, and swelling
III-complete tear of the ligament, you may hear a “pop” and see significant bruising and swelling
A ligament can also be torn from the bone, known as an avulsion.
What should you do?
It is best to be evaluated by a Doctor or Health Care Provider  to rule out a fracture, and determine the severity of the ligament injury. If it is a grade I injury; rest, ice and evaluation is best. The time of healing can vary from 6 weeks to 6 months, depending on the severity of injury and your  body. For example, your nutrition status, or if you have Diabetes. For a post on resting following an injury, and the stages of healing read Why You Should Rest Following an Injury.
For grades II and III injury,  a period of immobilization or in some cases surgery, may be required.  In this case,  due to ligament weakening during immobilization, the time of healing can be 12-18 months or more. Strengthening and return to activity following immobilization needs to be performed in graded stages. Too much too fast can set off the inflammatory stage (phase I of healing).
Rehabilitation
Again this depends on the severity. However, in the first 24-48 hours rest, ice, elevation is best.  As the inflammation decreases, or when a cast or splint is removed it is important to restore the mobility to the joint. A physical therapist can assist with the ROM, and educate you on exercises to perform at home. It is also important to evaluate your muscle strength, and joint laxity.  Your therapist will also give you a progression of  exercises to help restore normal strength to the joint. In the later stages you will also learn preventative strengthening to help reduce your chance for injury in the future, and as well as assist you with return to any sport activity.
Prevention
Flukes, and accidents happen. However, there are steps you can take to reduce your risk for a sprain. Off the field, or sport activity, stay as strong as possible. Strengthen from the ground up. To start see a previous post on ankle strengthening.  On the field establish a pre and post activity routine. Allow your muscles to slowly warm up before increasing your intensity. When you are fatigued, stop the activity. Cool down, and stretch your tight areas.


Contributed by Dr. Alison Cupini
References
Kisner, C. Colby, L. Therapeutic Exercise Foundations and Techniques. Davis Company, Philadelphia. 2007.
Levangie, P. Norkin, C. Joint Structure & Function A Comprehensive Analysis.Davis Company, Philadelphia. 2005.

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