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Sprains, strains, and fractures involve injury
to ligaments, muscles, and bones

By: Thomas Osborne, M.D.

When you went out to get the mail this morning, you slipped, missed the curb, lost your balance, and fell. Your ankle (or wrist, hip, or back) has been hurting ever since. It's likely that you have one (or more) of three common types of injuries: a sprain, strain, or a fractured bone.

Sprains
Ligaments are fibrous bands of tissue that connect bones to each other at a joint. A sprain occurs when ligaments are stretched or torn.

Sprains can vary in severity. A Grade I sprain involves stretching or slight tearing of the ligament. With a Grade II sprain, there is a larger tear to the ligament, and a Grade III sprain is an injury resulting in a complete tear of the ligament.

Generally, symptoms involve pain at the injury site, swelling, bruising, and tenderness to the touch. Symptoms intensify with the severity of the sprain. In more severe sprains, you may feel or hear a tearing sensation, a pop, or a snap at the injury site.

It is important to treat sprains appropriately. If a sprain doesn't heal correctly, the joint can become unstable, increasing the risk of reinjury.

Typical treatment for a sprain involves control of initial pain and swelling followed by adequate rest to allow healing. An ice pack, and an elastic compression wrap (such as an Ace bandage) will work to decrease swelling. Over the counter pain relievers such as ibuprofen also decrease swelling, while relieving pain. Keeping the affected area elevated is also recommended.

While resting the injured joint is recommended, it is important to resume a full range of motion as soon as possible after the injury – usually within 24 to 48 hours. Gentle stretching and movement will prevent the formation of scar tissue, which could hinder complete healing.

Strains
A strain results from the stretching or tearing of muscle tissue. Strains are often called “pulled muscles.”

Symptoms of a strain include sharp pain at the injury site, followed by stiffness, tenderness, and sometimes swelling and bruising.

Treatment of a strain is very similar to treatment of a sprain – rest, icing the injury, compression, elevation, and pain relievers work to support healing. Resuming use of the muscle and gently stretching the injured area within 24 to 48 hours will help to maintain range of motion in the long run.

When to call the doctor
With consistent treatment, most sprains and strains heal in two to three weeks. However, if you do not see a decrease in pain, swelling, or stiffness within two or three days, you should contact your doctor. Other reasons to call the doctor: an inability to move an injured muscle or bear weight on an injured joint, a popping sensation when you move the joint, a fever accompanied by redness at the injured area, the bones in an injured joint don't seem to line up properly, you have had repeated injuries to the same joint or muscle, or you have difficulty walking after injuring your back.

Your doctor will take a detailed history, ask you to describe the injury, and examine the injured area. He or she may order X-rays or an MRI to rule out bone fracture or ruptured tissues.

Fractures
A break of any size in the bone is called a fracture. If a fracture punctures the skin, it is called a compound fracture. A stress fracture is another type of break that appears as a hairline crack in the bone. Stress fractures develop gradually over time because of repeated or prolonged forces against the bone.

Symptoms of a bone fracture include swelling, bruising, intense pain, numbness, tingling, limited mobility or the inability to move the limb. There can also be broken skin, with a bone protruding, and bleeding.

Fractures are serious injuries and require the attention of a health care professional. You should call immediately for emergency medical assistance if there is severe bleeding, the bone is protruding from the skin, the area below the injury is pale, cold, and clammy, or the suspected broken bone is in the head, neck, back, hip, pelvis, or upper leg.

If someone is injured and you suspect they may have a bone fracture, do not attempt to straighten the bone, change its position, or test a bone's ability to move. Apply ice packs to reduce pain and swelling. If the injury involves bleeding, place a dry, clean cloth over the wound and apply direct pressure to the site. If you suspect a hip, pelvis, leg, or spinal injury, do not move or reposition the person. Keep the person still and calm while you call immediately for emergency medical help.

Treatment for a bone fracture will be prescribed by your doctor and will vary depending on a number of factors including location and severity of the injury, age and activity level of the patient, potential for healing, and another injuries.

Prevention
There are steps you can take to prevent the likelihood of a sprain, strain, or fracture. When you are in good physical shape, your body is better able to resist trauma. Being overweight puts added stress on joints, muscles, and bones. If you are overweight, ask your doctor about an appropriate diet and a general conditioning program.

Other preventative measures include wearing protective gear while skiing, biking, roller blading, and engaging in contact sports. Prevent falls. Do not stand on chairs, counters, or other unstable objects. Remove electrical cords, throw rugs and other objects from floor surfaces where people might trip over them. Use handrails on staircases and non-skid mats in bathtubs. Take extra precautions when walking on icy surfaces outdoors.

Keep children safe. Supervise them at all times – indoors and out. Gate stairways and keep windows closed and locked.

When it comes to injury, prevention can be key. Taking a few extra moments to ensure safety can keep you and a sprained ankle from ever crossing paths. Remember, the best type of sprain, strain, or fracture is one that never occurs.

Dr. Osborne is a board certified family practice physician at Raiter Clinic.