Q&A's on Common Injuries & Their Solutions: SPRAINS

By Anthony "Trooper" Sanchez, M.D.

As an intensely training athlete, you're used to pain. Muscle soreness and stiffness are part of the joy of using your body. Burning lungs are earned only by a super intense round of cardio. Nothing for the faint of heart. So a lot of athletes feel okay about pain. Maybe even a little proud.

But what happens when that pain gets a little more intense... once you've experienced an injury? If you're an intensely training athlete, you can pretty much count on an injury of some kind in your athletic "career." They just seem to be part of the territory. You may twist an ankle while running sprints at the track or playing a game of "pick-up" basketball. Or you could miss that tight curve on the trail while mountain biking and shoot headfirst over the handlebars. Maybe it's just an occasional ache in your elbow or wrist after a particularly grueling bench press routine.

But how do you know when the pain isn't something you should just shrug off or "work through"? How do you know when you're experiencing just a muscle ache versus an honest-to-goodness injury?

Well, after a couple of the editors at Real SOLUTIONS missed a workout or two after pushing a little too hard in our workouts, we decided this was a pretty good question. And one that could be answered only by an expert. So we asked our favorite orthopedic surgeon, Dr. Anthony "Trooper" Sanchez, to take a look at the most common sports/weight-training injuries and then to share with us:

• What to look for
• What to do
• How to expedite the recovery
• When it's time to check in with the doctor
• And how to prevent it from happening in the first place.

Here's what Dr. Sanchez had to say about one of the most common complaints—sprains—in our first installment in this series of articles on common injuries/complaints.

What is a sprain?

A sprain is an injury that causes a stretch or a tear in a ligament. Ligaments are strong bands of fibrous connective tissue that connect bones at a joint. They are composed of bundles of type I collagen and elastin. As ligaments insert into bones, the ligament material changes from rigid to more flexible.

What is the difference between a sprain and a strain?

A sprain is an injury to a ligament. A strain is an injury to the muscle and tendon (musculotendinous junction) as it attaches to bone. Often, a sprain is much more painful than a strain.

What does it mean when my physician says that I have a grade II sprain?

Medically speaking, sprains may be classified as grade I, grade II, or grade III. Grade I sprains represent stretching of the ligament without tearing. Grade II represent partial tearing of the ligament. Grade III represent complete disruption of the ligament and often hurt just as much as a broken bone.

What is the most common sprain seen in the athletic population?

A sprain of the lateral "outer" ligaments of the ankle is one of the most common injuries sustained with sporting activities. In fact, 85% of all ankle injures are sprains. Wrist and knee sprains are also quite common.

How does a sprain occur?

A twisting or severe stretching of a joint is the usual cause of a sprain. In regards to the ankle, a sprain occurs when an individual "rolls over" his or her foot onto the lateral ankle.

What are the symptoms?

Often, one hears or feels a "pop" or "snap" at the time of injury, which results in a swollen, painful joint. Following the injury, one may not be able to move the injured joint or have the ability to bear weight. The skin of the joint may be red at first followed by bruising in a few hours or days.

How are sprains diagnosed?

The diagnosis of a sprained joint begins with inspection of the injured joint to identify the location of swelling and bruising. This is followed by palpation of the bony and ligamentous anatomy to identify tenderness. An x-ray may be obtained to make sure you do not have a broken bone.

What is the treatment for sprains?

The goal of initial treatment is to minimize pain, swelling, and stiffness. The general rule for treating sprains is R.I.C.E. (See below.) Additional treatment modalities include anti-inflammatory medications and physical therapy.

Rest: Depending on the severity of the sprain, the usual treatment consists of immobilization with a splint, brace, or sling. In the acute inflammatory phase (one to five days after injury), rest promotes pain control. Upon resolution of the acute inflammation phase, only sub-maximal activity is recommended, to prevent further injury or re-injury. Prolonged immobilization is discouraged because of detrimental long-term effects such as muscle atrophy and joint stiffness. Protected weight bearing is used until symptoms resolve. Modify your activities and avoid those that cause pain. Occasionally, sprains to the knee and ankle may require crutches for ambulation.

Ice: Cryotherapy, that is, the application of ice, is recommended to improve the effects of the inflammatory reaction by reducing swelling, hematoma formation (localized blood collection in the soft tissue), and diminishing pain. It is hypothesized that ice therapy retards hematoma formation and swelling because it constricts the capillaries and thereby decreases blood flow. Several studies have shown that cryotherapy can either increase or decrease swelling. Therefore, its affects on inflammation and swelling are unclear. Regardless, it is still highly recommended in the acute phase.

In addition, numerous studies have shown cryotherapy to provide an analgesic (or pain relieving) effect. It is believed to be due to breaking the pain cycle by showering the central nervous system with impulses, which makes the receptors momentarily refactory to pain. This analgesic effect is well substantiated. Although the duration of the effect is not well defined, the temporary analgesia is helpful for early mobilization. In the acute phase, one should apply ice on the sprained area for 20 to 30 minutes every three to four hours. Do this for two to three days or until the pain subsides.

Compression/Elevation: The use of compression and elevation are thought to decrease pain and swelling. Although there are no studies that address the use of these modalities, their employment is generally recommended. An elastic bandage or neoprene sleeve may be used to reduce swelling. Also, elevation of the injured joint above the level of your heart will decrease the swelling. Most severe sprains may require compressive bracing for up to six months during sports.

In addition to the R.I.C.E. recommendations above, there are some other treatments available:

Nonsteroidal anti-inflammatory drugs (NSAIDS): These medications, such as Tylenol, Aleve, and Advil, have been used to reduce the acute pain caused by the inflammatory response. The inflammatory response involves the vasodilation of the vessels and collection of blood in the surrounding tissues. Inflammatory cells are recruited and result in swelling, redness, pain, and impaired function. Although these effects are detrimental, an inflammatory response is not absolutely undesirable since a certain level of inflammation may be necessary to allow healing to take place. The current recommendation is to use NSAIDS immediately after the injury and a short time thereafter but not to continue for a long period of time to prevent interference with the healing response.

Physical therapy: Physical therapy is recommended after the resolution of the acute pain and swelling. This is beneficial for restoring normal muscle strength and flexibility around the joint. Therapy is important to prevent further injury or re-injury. Active assisted, passive, and resisted range-of-motion with gait, balance, and proprioceptive training should be gradually instituted. The majority of patients will be able to return to full activity within six weeks of their injury. Though some sprains with complete tearing of ligaments may need surgery.

How long should I wear an elastic bandage or splint for a sprain?

The length of time depends on the severity of the injury, the activity involved, and the fitness level of the athlete. If the swelling is minimal, several days is usually sufficient. If there is an obvious hematoma or more severe pain owing to the swelling, a six-week taping protocol or commercially available protective splint is recommended. The splint is discontinued when the person feels comfortable and confident. The exception is those who have chronic or recurrent sprains; in this case, continued protection whenever the person is participating in agility sports is recommended.

How are sprains prevented?

Most sprains occur from accidents that are not easily prevented. However, make sure you wear appropriate shoes for your activities (for instance, don't wear sandals into the gym or running shoes to play basketball) and watch for uneven surfaces when you are walking or exercising.

Sprains in Summary

Trooper Sanchez, M.D. is an orthopedic surgeon at the prestigious University of Colorado Medical Center. Trooper worked for the professional football team The Minnesota Vikings as a medical supervisor. He provides elite athletes and everyday people injury prevention methods and techniques for working around injuries and rehabbing past injuries.

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