Strains and sprains can be painful and confusing to distinguish. Below is a brief interview I did for a book called The Anti-Pain Plan by Rick Chillot that provides a bit more clarity on the difference as well as some helpful hints you can do to improve recovery.
1) Is there a difference between a sprain and a strain? How do you know which you have? Is one more serious than the other?
Yes, there is a difference between a sprain and a strain. A sprain involves injury to the ligaments of a joint and often occurs when a joint is carried through a range of motion greater than normal. A strain involves injury to muscle often resulting from overuse or improper use ( torn muscle). Put simply, muscles get strained and joints get sprained.
Signs and symptoms of both sprains and strains are quite similar. The main differences being the location of the injury (part of the body affected –for example, is the main wrist joint affected or is the pain along the forearm) and the nature of the injury. Joints can be very complex anatomical structures. The best way to know whether you have a sprain or strain is to see a physician. The physician should take a good history, perform provocative testing, imaging, and physical exam to determine the diagnosis.
Both sprains and strains range in severity from first degree to third degree with third degree being quite severe. I wouldn’t say that one is more serious than another. However, it has been my experience that torn muscles (strains) take longer to heal the sprains.
2) What actions should be taken immediately after injury? Ice is the first thing that comes to mind…how often should you ice it? What else might you do? Do you need to immobilize the wrist? Do you need to keep it elevated?
The one word people need to know immediately after injury is R.I.C.E.- Rest, Ice, Compression, and Elevation.
Immediately after the injury, ice is the best treatment. Ice works to decrease inflammation and as an analgesic. Ice should be used for 20-25 minutes every 2 hours after injury for the first 24-48 hours.
Proteolytic enzymes (amylase, lipase, trypsin, chymotrypsin, bromelain, papain, and cellulase) may also help, and if used, should be started within 1-24 hours post-injury. These enzymes, when taken away from food, act as antiinflammatories and have been shown to speed healing time by a factor of two. The closer post-injury they are taken, the more benefit they will have. Proteolytic enzymes can also be used 1-2 days prior to high stress, high contact events (sporting events such as football, soccer, wrestling, running, etc) to aid the body in recovery and prevent some of the damage that may occur.
Elevation will help decrease swelling by draining fluids away from the affected area. This should be done for the first 24-48 hours post-injury and possibly longer depending on the extent of injury.
Immobilization provides the body time to heal by decreasing stress and activity of the affected area. Depending on the severity of the injury, immobilization may be necessary. However, in first degree sprains and strains, immobilization can lead to increased adhesion formation and decreased range of motion. Therefore, slow, gentle exercises performed without pain are recommended to maintain strength and range of motion, and to prevent scarring of the tissue.
Along with proteolytic enzymes, there are a few other supplements that may help.
• Vitamin C- 3-6 grams daily in divided doses: important in connective tissue formation, promotes tissue function and tissue integrity, antioxidant, immune enhancing
• Glucosamine sulfate/Chondroitin sulfate – 500mg three times a day: stimulates the production of glycosaminoglycans- important building blocks of cartilage (used in cases of sprains not strains)
• Essential Fatty Acids (fish oil) – 1 - 2 capsules each day: decrease inflammation, stabilize cell membranes
• Multi-Vitamin - general support. The body requires more nutrients when injured due to increased demand at the site of injury. A good multi-vitamin in conjunction with a healthy diet provides the body with the necessary ingredients to aid healing.
(You can find many of these products at The Organic Wholesale Club at discounted prices. Use the coupon code 'drjohn' for an additonal 5% off!)
3) As with other types of trauma, it is helpful to apply heat in the days after the injury. Is contrast hydrotherapy also useful here?
Heat is very helpful as it increases circulation and acts as an analgesic. However, it is important not to begin using heat too close post-injury as it may increase inflammation (do not use within 24-48 hours post-injury). After this time, heat can be very beneficial.
That said, contrast hydrotherapy is an excellent treatment for both strains and sprains and may be used sooner post-injury (if the heat aggravates, you may not want to do contrast hydro or the temperature of the hot water portion can be decreased). The alternation of hot and cold will increase circulation, decrease swelling, and speed healing. The greater the contrast between the hot and cold water, the greater the physiological response. However, smaller contrasts are better than no contrasts. So if heat aggravates, wait 1-2 days to do contrast baths or decrease the degree of contrast, emphasizing cold. 3 minutes hot, 30 seconds cold, repeat 3 times. Always end with cold.
4) If you want to use an over the counter analgesic, are certain types better for this than others?
I believe there are plenty of natural analgesics available. However, if I had to select one, I would tend to use ibuprofen. It is effective, inexpensive, and less harmful to the GI system. In more severe cases I may recommend naproxen. Recommendation would depend on patient response, history, and necessity.
As for topical analgesics, there are plenty out there. All work fairly well. Again, for me the more natural the better. Tiger Balm and Arnica are two of my favorites. The concern in using these analgesic products is that individuals believe if they can’t feel the pain, they can do whatever they wish without doing damage. Just because you rub something on and you can’t feel pain, does not mean that everything is OK. I recommend my patients use these topical analgesics sparingly. Analgesics work well at dulling pain, but they serve no other therapeutic value and are often misused.
Remember to always talk to your doctor if the pain or injury persists and before beginning any treatment. And drive safely.
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