Treating Common Sprains

Treating Common Sprains
A sprain can result from a fall, a sudden twist, or a blow to the body that forces a

joint out of its normal position. This results in an overstretch or tear of the ligament

supporting that joint. Typically, sprains occur when people fall and land on an

outstretched arm, slide into base, land on the side of their foot, or twist a knee with

the foot planted firmly on the ground.

Although sprains can occur in both the upper and lower parts of the
body, the most common site is the ankle. Ankle sprains are the most
common injury in the United States and often occur during sports or
recreational activities. Approximately 1 million ankle injuries occur
each year, and 85 percent of them are sprains.

The talus bone and the ends of two of the lower leg bones (tibia and fibula) form the

ankle joint. This joint is supported by several lateral (outside) ligaments and medial

(inside) ligaments. Most ankle sprains happen when the foot turns inward as a person runs,

turns, falls, or lands on the ankle after a jump. This type of sprain is called an

inversion injury. One or more of the lateral ligaments are injured, usually the anterior

talofibular ligament. The calcaneofibular ligament is the second most frequently torn

ligament.

The knee is another common site for a sprain. A blow to the knee or a fall is often the

cause; sudden twisting can also result in a sprain.

Sprains frequently occur at the wrist, typically when people fall and land on an

outstretched hand.

The usual signs and symptoms include pain, swelling, bruising, and loss of the ability

to move and use the joint (called functional ability). However, these signs and symptoms

can vary in intensity, depending on the severity of the sprain. Sometimes people feel a

pop or tear when the injury happens.

Treatment for sprains and strains is similar and can be thought of
as having two stages. The goal during the first stage is to reduce
swelling and pain. At this stage, doctors usually advise patients to
follow a formula of rest, ice, compression, and elevation (RICE) for
the first 24 to 48 hours after the injury. The doctor may also
recommend an over-the-counter or prescription nonsteroidal
anti-inflammatory drug, such as aspirin or ibuprofen, to help decrease
pain and inflammation.

For people with a moderate or severe sprain, particularly of the ankle, a hard cast may

be applied. Severe sprains and strains may require surgery to repair the torn ligaments,

muscle, or tendons. Surgery is usually performed by an orthopaedic surgeon.

If possible, keep the injured ankle, knee, elbow, or wrist elevated on a pillow, above

the level of the heart, to help decrease swelling.

The second stage of treating a sprain or strain is rehabilitation, whose overall goal

is to improve the condition of the injured part and restore its function. The health care

provider will prescribe an exercise program designed to prevent stiffness, improve range

of motion, and restore the joint's normal flexibility and strength. Some patients may need

physical therapy during this stage.

When the acute pain and swelling have diminished, the health care
provider or physical
therapist will instruct the patient to do a series of exercises several
times a day. These are very important because they help reduce
swelling, prevent stiffness, and restore normal, pain-free range of
motion. The health care provider can recommend many different types of
exercises, depending on the injury. For example, people with an ankle
sprain may be told to rest their heel on the floor and write the
alphabet in the air with their big toe. A patient with an injured knee
or foot will work on weight-bearing and balancing exercises. The
duration of the program depends on the extent of the injury, but the
regimen commonly lasts for several weeks.

Another goal of rehabilitation is to increase strength and regain flexibility.

Depending on the patient's rate of recovery, this process begins about the second week

after the injury. The health care provider or physical therapist will instruct the patient

to do a series of exercises designed to meet these goals. During this phase of

rehabilitation, patients progress to more demanding exercises as pain decreases and

function improves.

The final goal is the return to full daily activities, including sports when

appropriate. Patients must work closely with their health care provider or physical

therapist to determine their readiness to return to full activity. Sometimes people are

tempted to resume full activity or play sports despite pain or muscle soreness. Returning

to full activity before regaining normal range of motion, flexibility, and strength

increases the chance of reinjury and may lead to a chronic problem.