Sprained Ankle (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Muscle sprains and strains facts
- What is the difference between a sprain and a strain?
- What causes a sprain or strain?
- Where do sprains and strains usually occur?
- What are sprain symptoms and signs?
- How are sprains and strains diagnosed?
- How are sprains and strains treated?
- What is the recovery time for sprains and strains?
- Can sprains and strains be prevented?
- What is the prognosis of sprains and strains?
- Where can people find more information about sprains and strains?
- Find a local Orthopedic Surgeon in your town
How are sprains and strains treated?
When a muscle, tendon, or ligament fibers are damaged, the body will heal the area by producing scar tissue. The area that is injured needs to be kept relatively rested while healing.
first aid begins with rest, ice, compression, and elevation (RICE) and are keys elements in the treatment of both sprains and strains. More intense treatment can be required depending upon the injury and the patient's level of function. For example, an athlete who sprains the ACL of their knee may need to reconstruct the ligament, but an elderly patient who is less active may not need such an aggressive approach.
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 of activity. There is a balance between resting a part of the body enough to help with healing and resting it too much so that strength and range of motion are lost. 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;
- hamstring muscle located in the back of the thigh and flexes the knee;
- 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.
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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