Strains/Sprains

Question 1

Define Strains

Answer 1

Muscle or tendon injury – involves over contracting or lengthening a muscle causing tearing of collagen

Question 2

Grade 1 of a strain/sprain

Answer 2

Mild, overstretched, micro-tears
Localised pain and tenderness
Minimal bruising/swelling/loss of function
No loss of strength and ROM

Question 3

Grade 2 of a strain/sprain

Answer 3

Moderate, partial-tears
Immediate onset of all inflammatory signs
Poorly localised pain
Moderate swelling/bruising/loss of function
Painful and reduced ROM
Reduced strength and painful resisted movement

Question 4

Grade 3 of a strain/sprain

Answer 4

Severe, complete tear
Inability to contract, separation may be evident
May hear audible ‘pop’ or ‘crack’
Immediate swelling, pain and bruising
Over time symptoms may be lower than grade II

Question 5

Prevalence of strains

Answer 5

• More common in 2+ joint muscles as greater risk of overstretching
• Eccentric contractions (deceleration phase)
• Muscles with higher percentage of type II fibres

Question 6

Medical management of strains

Answer 6

○ Surgery - for grade III; physiotherapy required afterwards

Question 7

Physiotherapy management of strains

Answer 7

Depends on severity of strain – healing times
POLICE - protection, optimal loading, ice, compression, elevation; PRICE - swap optimal loading for rest.
Mobilisation – as soon as possible because increases chance of recovery
Strength / loading - once full ROM is recovered
Proprioception - after strengthening
Endurance training - depending on patients goals/lifestyles

Question 8

Define Sprains

Answer 8

Stretch and/or tear of a ligament
Usually caused by the joint being forced suddenly outside of its usual ROM, and the inelastic fibres are stretched to far

Question 9

Prognosis of sprains

Answer 9

most recover with conservative management
Although most severe require surgery to reconstruct ligament

Question 10

Prevalence of sprains

Answer 10

Commonly occurs in ankles

Question 11

Physiotherapy management of sprains

Answer 11

similar to strains
○ Dependent on severity – healing times
○ POLICE - protection, optimal loading, ice, compression, elevation; PRICE - swap optimal loading for rest.
○ Early mobilisation - increase chance of recovery
○ Early weightbearing - if appropriate
○ Exercises - encourage mobility in a safe way
○ Education - about injury and healing
○ Return to sport (if applicable)
○ Surgery - severe cases; physio required post-surgery