Strains and Sprains

We’ve all “pulled a muscle” at some time in our life. Many of us have even “rolled an ankle”. These are examples strains and sprains respectively. A strain is damage to muscle and or tendon. A sprain is damage of the ligaments which connect bone to bone. Of the two, the sprain is the worst injury because it can compromise the integrity of joints. Strains and sprains can occur through acute or repetitive trauma. In other words, they can occur through one single event or through multiple smaller events like frequent overloading. 

Signs & Symptoms of Strains and Sprains

Strains and sprains typically produce achy or sharp pain that occur mainly with movement. You may notice that simply not moving tends to ease your pain while any movement or muscle tension increases your pain. The pain is typically more at the further ranges of motion: hence the further you move, the more pain you feel. Likewise, strong contractions or stretching will increase your pain.

Muscles and tendons are active tissue that produce contractile forces. A strain can interfere with the ability to produce an action when that muscle or tendon is recruited. This is painful and can cause a decrease in the functionality of that muscle resulting in weakness. If there is a full rupture of the muscle or tendon, an individual will have complete loss of movement. Ruptures will also cause a ball where the muscle has contracted and wadded up on either side of the tear.

Ligaments are fibrous tissue that create stability in a joint. Their job is to keep the joint centered and make sure that the joint doesn’t slip out of place during motion. A person with a sprain will likely have a feeling of instability. They may sense that there is too much motion occurring at the joint. A person may note clunking, clicking, popping or shifting at the effected joint.

Causes of Strains and Sprains

Strains and sprains are caused by trauma. The trauma can be repetitive or from a single injury. This can occur in a car accident, sports injury, slip and fall, or other injury that delivers enough force. The most common cause we see is from a motor vehicle accident. Automobile collisions cause rapid acceleration and deceleration forces that result in tension on muscles and ligaments. These forces can rip and tear the tissues. Any force that causes rapid tension in these tissues can result in strain and/or sprain. The second most common cause of strain and sprain we see is related to sports injuries. We also see quite a bit of repetitive strains and sprains with seemingly normal activities like lifting at the gym or even yard work. Other repetitive actions like racket sports or golf can also create microdamage producing strains and sprains.

Both muscles and ligaments can help to center a joint and keep the two bone surfaces of the joint in approximation. When it comes to protecting a joint against excessive motion, the body’s first line of defense is actually the muscle groups that cross and surround the joint. Strong muscles create stability, especially if they are well balanced around the joint. If this first line of defense is broken, then the motion will continue until it loads up on the ligaments. If the force is strong enough to get to this point, then continued motion results in breakage in the fibers of the ligaments. This is why strains can occur alone, but typically sprains occur along with strains.

Treatment of Strains and Sprains

At Reactivate Chiropractic & Rehab, we carry our patients through phases of care that pay close attention to the healing process in an injury. At first we start with PRICE (protection, rest, ice, compression, elevation), nutrition to assist in tissue repair, and possibly some gentle ultrasound to help increase metabolism in the area to speed up healing. Then we begin with gentle soft tissue manipulation and mobilization. If the trauma has resulted in joint dysfunction, we may go ahead and do some joint manipulation as well. We then move through progressively intensive rehab moving and stretching. Finally, we begin a progressive strengthening phase and stepwise reintroduction to normal activities until maximal recovery is made and you can perform normally again.

Inflammation and Repair

The inflammatory process is essential for healing to occur. However, our diets and environment often create an inflammatory reaction that is actually stronger than needed. Therefore, initial treatment of strains and sprains requires controlling the amount of inflammation. It is also essential to give the body what it needs to repair those damaged tissues.

P.R.I.C.E Method

The P.R.I.C.E. method is a great strategy. The pneumonic PRICE has been adopted to indicate: Protection, Rest, Ice, Compression, and Elevation. In general, this is advisable in the first week or so. Protection for the area with wraps or braces helps to avoid motion. Rest allows your muscles and ligaments to heal as they aren’t being stressed. Ice is good to limit inflammation and swelling. Compression and elevation are also aimed at reducing swelling. 

Nutrition & Diet

Controlling your diet is another strategy for handling inflammation and can even help with repair of strains and sprains. What you put in your body effects the inflammatory process significantly. Food containing processed ingredients like refined flour, processed sugars, and modified fats produce more inflammation. Avoiding these ingredients can help quite a bit. Plants contain many components that can have powerful anti-inflammatory and antioxidant effects. Foods containing a good portion of omega-3 fatty acids are also directly anti-inflammatory. The “De-flame” diet as prescribed by Dr. David Seaman is an excellent example of such a diet.

Supplementation

Supplementation is another way to get ahead of inflammation. Many supplements contain nutrients that not only control inflammation, but help give the body what it needs to repair. We offer several different formulas that can be utilized to achieve repair and suppress inflammation.

Scar Tissue and Adhesions

Further along in the healing process, scar tissue formation begins to repair the area. When you damage connective tissue, such as muscle or ligament, the body lays down scar tissue to connect the broken ends back together. This is part of the necessary healing process. However, the scar tissue can create it’s own set of problems. Inappropriate scar tissue formation can lead to weaker tissues and unwanted adhesions.

Normal healthy tissue has its fibers aligned running mostly in one direction/plane forming a pattern that gives the tissue its strength and resilience. This is much like the threads in a cloth. Unfortunately, scar tissue fibers are laid in a random fashion crisscrossing in different directions. Fibers that are not aligned do not have the same structural integrity. Therefore, scar tissue is weaker than the original tissue. In fact, scar tissue is presumed to only achieve 80% maximum strength versus the original tissue, even after years of healing. You can see why you might want to influence the pattern of scar tissue formation to improve it’s strength.

Scar tissue formation is like the body adding glue to the holes and tears. It not only binds the damaged tissues, but also creates unwanted connections. As mentioned, scar tissue is laid down randomly which leads to attachments to all of the surrounding damaged tissue. This results in adhesions between tissues that need to move and slide relative to one another. If scar tissue creates these adhesions, the normal sliding motion of tissues will be limited as a result of tethering. You can see how allowing scar tissue to form crosslinking adhesions could end up giving you more issues down the road.

Soft Tissue Manipulation

To understand why soft tissue manipulation and massage affects healing, you must understand how the fibers in scar tissue form. These fibers are laid down slowly over time. The areas where there is movement and shearing causes these fibers to break and only the threads that are in line with the movement remain. This motion, even though we are technically doing some damage, results in more of the threads being aligned. This in turn results in tissue that more closely resembles the original healthy tissue. It also helps to break up adhesions that would otherwise cause the “gluing together” of adjacent structures that would limit mobility and functionality.

This is why the many experts recommend beginning certain therapies just a few days after injury. The sooner we can start breaking up the unwanted fibers that are not aligned, the more your body will produce stronger and healthier tissue. This is a sort of balancing act because we don’t want to rip the beneficial fiber links, but we do want to discourage inappropriate links and influence scar structure. This is a fine art and it takes a well-trained and well-practiced hand to know just how far to go.

Mobility

Traditional treatment for strains and sprains involves a lot of rest. However, this does not prevent inappropriate scar tissue formation which will likely lead to tissue weakness and adhesions. While resting the injured area is a good idea at first, research shows that motion is key early on (within a few days) to regain maximum normal function. 

The fibers of scar tissue do not align well on their own. Proper movement influences scar tissue formation in one direction or one plane. This also prevents crosslinks from forming between tissues that are meant to slide past each other.

Besides preventing inappropriate scar tissue formation, motion is important for another reason. To heal, the body needs to bring in more nutrients and dispose of the unwanted waste. This is akin to a construction sight. The increased demands of material exchange needs to be met by increased blood supply (which is part of swelling and inflammation). Appropriate motion also facilitates this process. Motion helps to pump more blood which helps with the nutrient exchange necessary for repair. This is why it is important to begin appropriate exercises as soon as possible.

Stretches and Exercises

Strains and Sprains require low-force motion exercises as early as within two weeks. Later on down the line, treatment should include stretches and strengthening exercises aimed at regaining normal function and physiological movement. More severe strains and sprains may require surgical repair, but will still need appropriate rehab afterwards. Patients should not self-prescribe exercise after injury. They should follow the prescription of a trained professional. Appropriate rehab involves a steady progression towards specific goals. Going to far or too fast can result in exacerbation or re-injury. This is why patient’s need the guidance of a doctor or therapist to achieve maximum clinical outcomes.

Prognosis of Strains and Sprains

Strains and sprains are graded on a scale from small minimal tears to full blown ruptures. Prognosis depends on the severity of the strain/sprain and also the timeline of beginning treatment. The earlier the correct diagnosis and management of the condition, the better the outcome. Full or substantial rupture of ligaments and tendons often requires surgical intervention. The intervention must occur in a timely manner or the damage will lead to long term instability resulting in further damage down the line.

Whether it be a sports injury, a fall, lifting too heavy, or been in an auto accident, most of us have experienced a soft tissue injury. Tulsa and the surrounding area can rely on Reactivate Chiropractic & Rehab for injury care to make a speedy recovery and return to the action. If you have sustained a sports injury or have been in an auto accident, please do not wait. Even a few days can make a big difference. Make an appointment today and see what Chiropractic injury care can do for you.