A sprain is an injury to a ligament, the tough band that connects bone to bone. A strain is an injury to a muscle or a tendon, which connects muscle to bone. They feel alike, but they happen in different tissues, and knowing the difference helps you choose the right care.
What is a sprain?
Ligaments hold your joints together. When a joint twists or bends past its normal range, the ligament can stretch or tear. Ankles, knees and wrists are the most common spots.
Typical signs of a sprain are pain around the joint, swelling, bruising and a joint that feels loose or hurts to put weight on. You may hear or feel a pop at the moment of injury.
What is a strain?
A strain, often called a pulled muscle, happens when a muscle or tendon is overstretched or torn. It can occur during a sudden sprint, a heavy lift or a hard push, or it can build up from overuse. The hamstrings, calves, quads and low back are common sites.
Signs include muscle pain, tightness, cramping or spasm, swelling, bruising, and weakness when you use the muscle. Stretching or squeezing the muscle often hurts.
Back strains are very common too, often after lifting or twisting. They usually feel like a deep ache or tightness in the low back, and most improve with gentle activity. Pain that shoots down a leg or comes with numbness needs an exam.
Grades of injury
Doctors often describe sprains and strains by grade, based on how much of the tissue is damaged.
- Grade 1 (mild): the tissue is stretched with tiny tears. There is mild pain and swelling, and you can usually still move and use the area.
- Grade 2 (moderate): a partial tear. Pain, swelling and bruising are greater, and the joint or muscle is weaker. Using it hurts.
- Grade 3 (severe): a complete tear. Pain is strong, the area may be unstable or you may not be able to use it, and a gap or bulge can sometimes be felt in a muscle.
How to care for it at home: RICE
For mild injuries, RICE is a helpful start in the first day or two.
- Rest: stop the activity and protect the area. Avoid putting weight on it if it hurts.
- Ice: apply a cold pack wrapped in a cloth for about 15 to 20 minutes at a time, several times a day. Never put ice directly on the skin.
- Compression: wrap the area snugly with an elastic bandage, but not so tight that it causes numbness or tingling.
- Elevation: raise the injured area above the level of your heart when you can to help swelling.
Getting moving again
Total rest for too long is not ideal. After the first couple of days, gentle movement helps the tissue heal and prevents stiffness. Start with easy range of motion, then add strength work as pain allows.
Return to sport slowly. Going back too early is a common reason injuries come back. A good rule is to return only when the area is pain free with daily tasks, has full motion, and feels about as strong as the other side. Over the counter pain relievers can help some people, but check with your doctor if you have other health conditions or take other medicines.
Why the right diagnosis matters
Pain alone does not tell you how bad the injury is. A bad sprain can feel just like a broken bone. A strain can hide a torn tendon. An exam and an X-ray, which we offer in the office, can tell the difference. Treatment for more serious injuries can include bracing, rehab guidance, injections or surgery, depending on the case. Dr. Marisa Formica focuses on non-surgical care and rehab plans for active people, and Dr. Mehran Manouel can discuss surgery when a complete tear needs repair.
When to see an orthopedic doctor
Go to the ER or call 911 if a bone looks out of place, there is an open wound, the limb is numb, pale or blue, or the pain is severe. See an orthopedic doctor if you cannot put weight on the joint, you heard a pop, the area is very swollen or bruised, the joint feels unstable, or pain is not improving after several days. Able Orthopedic & Sports Medicine in Forest Hills can examine the injury, take X-rays in the office and make a plan. Call (718) 897-2228 or book online.
Common questions
How can I tell a sprain from a strain?
A sprain affects a ligament around a joint, and a strain affects a muscle or tendon. A doctor's exam is the best way to be sure.
How long does a sprain or strain take to heal?
Mild injuries may improve in a couple of weeks, while moderate or severe ones can take longer. Healing varies from person to person.
Should I use heat or ice?
Ice is usually used in the first days to help with swelling and pain. Heat may feel better later for stiff muscles.
Can a sprain be a broken bone?
They can feel alike. If you cannot bear weight or the area is very tender over the bone, get an X-ray.
This article is for general education and is not a substitute for a visit with a doctor. If you think you have a medical emergency, call 911.