Fracture, Strain or Sprain? Tips + Treatment Options

When you suffer an acute injury, such as twisting an ankle or landing wrong  on your knee, it can be hard to understand what just happened and what you need to do. We asked Dr. Shaheer Yousaf, an orthopaedic surgeon, to explain the three most common types of acute injuries – strains, sprains and fractures – and when you should see a doctor.

1. How would you define a sprain, a strain and a fracture? From the pure medical and technical standpoint, a sprain is an injury sustained by a ligament. Ligaments attach bones together in a joint. A strain, on the other hand, is an injury or tear to muscles or tendons. Your tendons attach muscles to bones. It can be hard for patients to tell the difference between these two injuries. A fracture is more straightforward, as it involves a break in the hard bone.

2. Are there any differences in symptoms or pain that would make it easy to identify if you have a broken bone vs. an injured ligament or tendon? A deformity at the site of injury is an immediate, tell-tale sign of a broken bone, although it’s not always present. There will also be significant and rapid swelling, due to bleeding, and that is usually followed by a high-grade pain.

A sprained ligament will typically involve some swelling and result in joint instability. Because ligaments link bones together, if they fail, the joint becomes more floppy and unstable.

A strained tendon doesn’t usually cause much swelling or pain. But you’ll notice that something is not moving correctly because the muscle isn’t properly connected. If you tear a tendon in front of your ankle, you may not be able to lift your ankle up or down. If you tear it in the back of your shoulder, you may not be able to lift your arm up. Strains are less painful, but there is a noticeable inability to move that part of the body.

3. What are the most common muscles to strain? It’s really common to strain your back muscles. After the back, the most frequent strains are found the lower extremities – hamstring and calf muscles. These are at the very top of the injury list because your legs, ankles and feet support your entire body weight and take a significant degree of beating. You may think simply walking isn’t a big deal, but the physics of that motion requires your foot to support 10 times your body weight with every step. That’s why it’s so common to see lower extremity muscle strains.

4. What are the most common ligaments/joints to sprain? The same parts of your body – your back and lower extremities – are also more susceptible to sprains. But knee injuries top the list of ligament sprains. Any twisting motions – which are so common in sports like soccer, football, hockey and even running – can cause a sprain in the knee or ankle. Another common sprain is in the elbow and shoulder, especially if you participate in throwing activities like baseball.

5. When should a patient see an orthopaedic physician with a sprain, strain or fracture? It depends on the severity. Minor aches and pains may not need medical treatment to heal. For example, if you feel minimal impact from the injury and can continue your original activity, you’ll probably be fine. If the swelling and pain are minimal and you can still move the injured body part, then you can wait and see if it heals on its own before seeing a physician. But if it’s anything more serious – if there is deformity, swelling, significant pain or an inability to support your weight – you should see a doctor right away.

6. What should you do if you have a suspected strain or sprain? You follow the years-old principle of RICE – rest, ice, compress and elevate. This minimizes the swelling, and the less swelling you have the faster you can heal. After a period of time, take a look at the injury and see how you feel. If you’re not in too much pain and the swelling is going down, and you feel you can return to your activities, then do so cautiously. But if it’s not minor and the swelling continues, get help.

7. What about if you think you have a broken bone? The best thing to do would be to get help immediately.

8. What kind of physical therapy is involved for a severe sprain, strain or a fracture? Therapy is not essential in every case of strain and sprain. Healing is a biological process and has its own pace of progress. In many cases, basic movements and exercises can help to rehabilitate from the injury. However, if you experience stiffness or weakness at the site of injury, or have lost strength, endurance or motion, you should go to physical therapy to assist the healing process.

9. How long do these injuries usually take to heal? Typically sprains, strains and fractures will heal within 6-12 weeks, depending on how much pressure is on the thing that has been injured. If the injury involves a joint, it typically takes around 12 weeks to heal, but can be as short as six weeks if the injury is not on a joint. Some uncommon injuries can take more time.

10. Are there any ways to protect joints and ligaments from injury, and prevent sprains or strains? If you are an athlete, the most important step is to simply understand your sport and which joints or muscles it affects the most. Then, you need to understand your body and how your strengths and weaknesses align with those pressures. You may want to get appropriate training so your body is compatible with the challenge of those sporting or high-impact activities. Finally, before every sport or exercise, you should conduct a good warm-up to stretch and loosen your muscles, ligaments and tendons. Never continue with a game or workout if you have weakness, stiffness or excessive pain. These three things will compromise your body and can very quickly lead to a joint injury.

Dr. Shaheer Yousaf is an orthopaedic doctor at the Center for Advanced Orthopaedics care center in Waldorf, Maryland. He has received a number of awards for his care and has been practicing for more than 40 years.