Musculoskeletal injuries: Sprains

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Sprains are also known as torn ligaments. Sprains vary in their severity. Mild to moderate ones can heal within about 6 weeks, while severe ones can take months or years. Although they can occur in any joint – the wrist and the ankle are the most common sites. Sprains can be recognised by the following symptoms: decreased ability to move the damaged limb, popping sound in cases of complete rapture, difficulty using the body part, pain, swelling, bruising. 

Identification
 
Physical examination is often sufficient to diagnose a sprain. An X-ray may be needed sometimes to rule out a fracture. Magnetic resonance imaging (MRI) may be required if there are complications or healing takes excessively long.
 
Causes and risk factors
 
Sprains occur when the inelastic fibres are stretched beyond their range and the ligament is torn.
 
Certain factors can make sprains more likely. Fatigued muscles provide less support for the joint which can overstress and eventually rupture the joint ligaments. Sprains also occur often in people who suddenly increase their level of activity having been previously sedentary. Lack of proper warm-up is often cited as another risk factor for damaging ligaments.
 
Classification
 
Grade I sprains are also called ‘mild’. There is only some micro-tearing of fibres and some accompanying pain. This leads to mild swelling with local tenderness and mild discomfort with no obvious symptoms. Usually, there is no loss of function and the RICE (raise, ice, compress, elevate) protocol is used for management. The skin can become discoloured from underlying rupture of blood vessels – a condition called ecchymosis. Massage treatments are contraindicated in the acute phase.
 
Grade II sprains are also called ‘moderate’. The ligament is not completely torn but the rupturing of fibres is more extensive. Pain is more intense and usually, there is bruising and swelling. The joint becomes unstable as a result and bearing weight adequately is difficult or impossible. Nearby muscles usually become weak as a response. There is a limited range of motion in that joint and some form of bracing to immobilise it may be required.
 
Grade III sprains are also called ‘severe’. The tear is usually complete and there is a major loss of tissue continuity. The functionality is severely compromised. Strong pain and significant swelling take place in the affected area. There may be a loss of range of motion or the affected are may become excessively mobile as there is not ligament to support it. The joint is usually completely unstable and unable to bear any weight.
 
Common sites
 
The ankle is by far the most common site of ligament damage. The ligaments in the joint are not particularly big or strong but they need to be able to withstand the force generated by the whole-body weight. Most people’s proprioception in the feet is somewhat lower compared to other parts of the body. This makes inattentive foot movements leading to a sprained ankle more likely.
 
Another common sprain an anterior cruciate ligament (ACL) tear in the knee. It is common in sports and athletics like rugby, football, pole vaulting, as well as some martial arts.
 
The fingers, wrists and toes are also susceptible. This is because the ligaments are designed to support and stabilise the joint itself. In cases such as a fall, for example, the force transmitted through the whole body weight exceeds the structural capacity of the ligaments in question.
 
The ligaments between the spinal vertebrae are also susceptible to damage and tears. They can occur due to excessive stress, such as heavy deadlifting with improper form or due to underlying pathological degeneration of the tissues.
 
Healing and recovery
 
The RICE protocol mentioned above is typically the best response in the acute phase lasting up to 3 days after the injury. Anti-inflammatory medication and painkillers can also be taken. Of course, these must be used judiciously if at all. The convenience and pain relief they bring are dwarfed by weakening the immune system and interfering with the body’s natural healing cycle.
 
In the recovery phase, it is important to resume activity in a safe and controlled manner as soon as possible. This promotes recovery of the damaged tissue and reduces the risk of muscle atrophy in the surrounding area. Progressively increasing the range of motion of the joint and strengthening it with exercise must be a priority at this stage.