A. Sprains

What are they? Sprains are tears in ligaments.
What is a ligament? A ligament is a strong band of connective tissue that attaches one bone to another bone. Ligaments are found in all joints of the body. The knee, for example, has four major ligaments: medial collateral ligament (MCL), lateral collateral ligament (LCL), anterior cruciate ligament (ACL), and posterior cruciate ligament (PCL).

The purpose of ligaments is to be strong enough to hold two or more bones together at a joint but also loose enough to allow movement at that joint. Ligaments are aligned so that they have a specific direction that they hold the bones from going.
Ligaments are injured due to excessive stress placed on the ligament in the direction that the ligament is aligned. For example, the MCL of the knee holds the bottom bone of the knee (the tibia) from moving outward. If the tibia is forced outward, there is stress placed on the MCL. If this stress is too much the MCL may tear.

So what exactly is a sprain? Are they all the same? Not all sprains are the same. Sprains are classified into three general types based on the severity of ligament tear. Think of how a rope is made. There are small strands that are put together into bundles. These bundles are woven together into one strong rope. This is basically how a ligament is made. A first degree sprain, the least severe sprain, is a tear in the small strands of the ligament. A second degree sprain is a tear of one or more of the bundles of the ligament. A third degree sprain is a complete tear of the entire ligament.

Why is there swelling with sprains? When you sprain a ligament there is usually some swelling. There are two reasons for this. The first is that ligaments have blood vessels within them to give blood to the ligament. When a ligament is torn, so are the blood vessels, and bleeding into the surrounding area occurs. Extra blood needs extra room, so the joint swells. The second reason is that with any injury in the body, the body kicks in it’s protection and repair team to help heal the injury. To do this, special repair cells are sent through the blood to the area. The body wants to get as many of these repair cells to the injured area as possible and so sends extra blood to the injured area by expanding the local blood vessels. This extra blood causes fluid to leak out of the blood vessels and into the surrounding area. Again, extra fluid needs extra room. This is called the inflammatory response. Think about what happens when you scratch an itch too vigorously. It gets red and puffy, right? This is the same thing.

So why is swelling a bad thing? First of all, swelling means that you’ve injured something. That’s never good. But, too much swelling can actually be harmful. When you injure something, the body tends to overreact. It will send too much blood to the injured area and so there may be a lot of swelling. Too much swelling causes the tissues to stretch and this can be painful. As well, too much swelling means that not enough blood can get away from the area. Once the repair cells have started to repair the injury, there are waste products that need to be taken away in the blood.

So what do you do if you sprain a ligament? You RICE it. At least at first. RICE stands for Rest, Ice, Compression, and Elevation. The first priority is to protect the area from further injury. So stop whatever you’re doing. Next, because the body overreacts, you need to try to reduce the swelling. You do this by icing, compression and elevation. Which is most important? Think of a water hose. What’s the best way to stop a hose from spouting water? Step on it. Compression is the most effective way to reduce swelling, if combined with the other two. Elevation will let gravity assist in getting some of the blood back up to the heart. Ice will reflexively decrease the size of the blood vessels, so less blood can enter the area.
So how do you do this? You should ice the area, with compression and elevation, immediately after the injury. You should place a wet towel or other fairly thin material between the ice and your skin. For a sprain, only ice for 10 to 12 minutes. Anything longer and the blood vessels will begin to open up much wider than they were before and we don’t want that. Compress the area with a tensor bandage over top of the ice bag, applied in a spiral, from the bottom up. And lie down with the injured part supported above the heart. Once finished icing, reapply the tensor. Wear the tensor for the next three – five days, but not at night. Elevate the limb whenever possible.

How do I protect the area? A good guideline is don’t do anything that hurts. Pain is an indication that you’re doing more damage or about to do more damage. What happens if you cut yourself, a scab forms and you pick the scab. The healing can take a very long time and then you’re left with an ugly scar. This is similar to what happens to ligaments if you move when it hurts. The ligament will re-injure itself and there will not be good healing. So this means that if you’ve sprained your knee or ankle and can’t walk without a limp, then you need to use crutches.

What if I’ve hurt myself and I don’t know if I should stop playing? Here’s some guidelines. No matter what is injured, you need to be able to move the injured joint or the joints above and below the injury through the full range of movement without pain. As well you should be able to contract the surrounding muscles to a maximum without pain. Finally, you should be able to perform movements that are similar to those needed to play your sport without pain. If you feel any pain during these movements and activities or if you’re not at full strength, then you should NOT continue to play and you should get help.
When can I start playing again? The time it takes for a ligament to heal is about six weeks. More severe sprains will require that long for the “scab” to completely heal. With less severe sprains, you can usually return much sooner than that. But, remember, you can’t start playing until you can do the things listed above. You should leave that judgment up to your physical therapist or doctor.

B. Strains

What are strains? Strains are tears in muscles and tendons. You’ve heard of a pulled muscle, haven’t you?
I think I know what a muscle is but what exactly is a tendon? A tendon is a strong band of connective tissue that attaches muscles to bones. It is almost exactly the same as a ligament except a tendon is more elastic. A tendon is made of elastic like strands that form bundles which are woven into a tendon. Remember the rope? The job of tendons is this. When a muscle contracts, it pulls on the tendon which then pulls the bone in the direction you want it to move.

Are strains in muscles and tendons anything like sprains in ligaments? Kind of. They are classified in a similar way but the reason they happen is pretty different. Strains can be first degree, second degree or third degree just like sprains. The most common place for strains to occur is at the place where the muscle joins to the tendon but the can occur in the belly of the muscle or the tendon.

Why do people get strains? There are two ways that strains can happen. Either a strong contraction of the muscle or a forced stretch of the muscle. But usually it’s because of a combination of both a stretch and a strong contraction. For the most part, muscles and tendons can handle the stresses required in your sport if they are properly warmed up and stretched before a game or practice. Most strains occur when you haven’t warmed up properly or at all.

So how do you treat strains? Well, how did you treat you ligament sprain? You RICE it. When you injure a muscle or a tendon, the same bleeding and inflammatory processes occur as they do in any other injury. There will likely be some swelling with strains as well. So stop the hose from gushing.

If I’ve strained a muscle or tendon, should I stop playing? Follow the same guidelines for returning to play that were given for sprains. If it hurts, don’t do it, and get help.

When can I return to play? Tendons usually take a little longer to heal than ligaments. If you’ve badly strained a tendon, it may be up to eight weeks before it is healed enough to begin playing. But, if you’ve strained a tendon or a muscle, you should see a physical therapist to get exercises so that when you do return, you won’t reinjure yourself. This goes for any injury.