What Is the Difference Between Sprains and Strains?

Sprains and strains are common musculoskeletal injuries that can cause significant pain, swelling, and impaired joint movement. However, sprains differ in that they involve the stretching or tearing of a ligament, while strains involve the stretching or tearing of a muscle and/or tendon.

Sprains and strains can also differ by their causes and the parts of the body they affect. Sprains are often caused by the twisting of a joint such as the ankle, knee, or wrist, while strains are often caused by the overuse or forceful impact of the neck, back, or hamstring. Even so, both can be treated with the RICE method, over-the-counter painkillers, and rehabilitation.

Anatomical Differences

Sprains and strains are musculoskeletal injuries involving the muscles, bones, joints, and connective tissue that enable fine (small) and gross (large) body movements. The main difference between sprains and strains is the tissues they affect:

• A sprain is a soft tissue injury of a ligament. Ligaments are tough, inflexible bands made of collagen that connect two or more bones to form a joint. These fibrous bands of connective tissues help keep joint stability while moving or when bearing weight.
• A strain is a soft tissue injury of a muscle, tendon, or both. Tendons are also stronger but are thinner and more elastic than ligaments. Their function is to transmit force from bones to muscles, facilitating movement and absorbing shock while running or jumping.

Causes

Sprains and strains can be caused by many of the same injuries. This is due to vulnerabilities in the structure of ligaments and tendons, which are similar.

Ligaments and tendons are made of fibers that are positioned horizontally, vertically, and in spirals to limit the degree they can stretch (referred to as extension). The configuration also allows them to return to their normal position after stretching (referred to as contraction).

While the general makeup of the tissues is similar, there are differences:

• With ligaments, the fiber configuration is tighter, denser, and thicker to keep joint bones stable.
• With tendons, the configuration is looser and thinner to enable joint movement. Tendons are also better able to stretch due to the elasticity of the muscles they are attached to.

The differences create distinct vulnerabilities that lead to injuries in different ways:

• Sprains commonly occur when a joint is twisted or wrenched. Common sites include the ankle, knee, and wrist. Examples include a sprained ankle caused by twisting your ankle on an uneven surface, a sprained wrist caused by landing on an outstretched hand during a fall, or a sprained knee caused by pivoting awkwardly during sports.
• Strains commonly occur due to abrupt force placed on a joint at high velocity. Common sites include the back, neck, calf, shoulder, or foot. An example is back strain or rotator cuff strain caused when you lift something heavy with a jerking motion. Whiplash is another example in which the head snaps sharply back and then forward, such as when a car is hit from behind.

Strains can also be the result of a repetitive-use injury caused when a body part repeats the same motion over and over. This can occur with sports like tennis or occupations like construction. Over time, the wearing down of ligaments can lead to overstretching and tears.

How to Tell the Difference

Symptoms of a sprain and strain are often distinguishable at first glance. However, there are key ways to tell them apart.

Because sprains involve ligaments designed to keep joints stable, you are more likely to experience joint instability and a feeling that a joint is "giving out" when placed under weight-bearing stress.

In contrast, strains involve muscles and tendons that enable movement. Because of this, you are more likely to experience muscle-related symptoms like muscle pain and spasms.

Additionally, you are less likely to experience bruising or hematomas (blood pockets) with a sprain because ligaments have no blood vessels passing through them. With a strain, bruising and hematomas can occur if a muscle is torn.

Diagnosis

Sprains and strains are diagnosed in the same way. A great many cases can be diagnosed based on a review of your medical history and symptoms, along with a physical examination.

During the physical exam, the healthcare provider will look for signs of swelling or bruising, check the range of motion of the joint, and press on the affected area to see if and where pain is felt.

If there is any doubt as to the cause, you may be sent for an X-ray to rule out a bone fracture. An ultrasound or magnetic resonance imaging (MRI) can also be used to image soft tissues and confirm if a rupture (tear) has occurred and to what extent.

Grading

After the examination, your provider will determine the grade of your sprain or strain to help develop a treatment plan. Sprains are graded based on how much damage has occurred to the ligaments, while strains are graded based on how much damage muscles and tendons have sustained.

Sprains and strains are classified by three grades, with Grade 1 being the least serious and Grade 3 being the most serious.

Treatment

The treatment of sprains and strains primarily involves the RICE method, a home-based intervention commonly used for uncomplicated musculoskeletal injuries.

RICE is an acronym for:

• Rest: Walking and other forms of weight-bearing stress are avoided for one to three days, depending on the severity of the injury.
• Ice application: This involves icing the injury for 10 to 15 minutes several times a day to reduce inflammation along with pain, swelling, and bruising.
• Compression: This involves the use of a compression or ACE bandage to limit swelling, stabilize the affected joint, and reduce pain.
• Elevation: This involves elevating the affected limb above the level of your heart to further reduce swelling and ease throbbing pain.

In addition, you can take an analgesic pain reliever like Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory drug (NSAID) like Advil (ibuprofen) or Aleve (naproxen).

For more serious injuries, immobilization of the joint with a brace, splint, walking boot, or cast may be needed.

Options for Severe Sprains and Strains

Once acute symptoms are eased, the focus of treatment is placed on rehabilitation. This may involve physical therapy, in which exercise, hands-on treatments (like massage therapy), and devices like electrical stimulation help ease pain, restore joint function, and promote healing.

The recovery time can vary from several days to six weeks for mild to moderate sprains or strains, to several weeks or months for severe injuries.

Surgery is not a common part of recovery from a strain. On the other hand, surgery may be considered for a severe sprain if multiple ligaments or a complete rupture is involved. Such high-grade sprains often lead to chronic instability or recurrent sprains if left untreated.

How to Prevent Sprains and Strains

Sprains and strains can't always be prevented, but there are things you can do to reduce the risk, including:

• Maintaining a healthy weight
• Regular stretching before exercise and cooling down after
• Strength-training program adapted to your needs
• Stability exercises to improve balance and prevent falls
• Proper footwear for your sport or occupation
• Wearing protective gear, like knee pads or shin guards for high-impact sports

Summary

Sprains involve the overstretching or tearing of a ligament, while strains involve the overstretching or tearing of a muscle and/or tendon. Symptoms include pain, inflammation, and difficulty moving the injured part. While sprains are mostly caused by the twisting or wrenching of a joint, strains are usually caused by excessive force placed on a joint at high velocity.

Sprains and strains can usually be diagnosed with a physical exam and a review of your medical history. Rest, ice application, and oral painkillers are among the standard treatments for uncomplicated sprains and strains. In severe cases, casting and surgery may be needed.