Recovering From 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.