Ligament Sprain

Original Editor - Rachael Lowe

Top Contributors - Lucinda hampton, Rachael Lowe, Wanda van Niekerk and Kim Jackson  

Introduction

Ankle-Sprains.jpg

A sprain is an injury to the band ie ligament, which connects two or more bones to a joint. A sprain is usually caused by the joint being forced suddenly outside its usual range of movement and the inelastic fibres are stretched through too great a range. A severe sprain may look and feel like a break (fracture), and it can be difficult for health professionals to tell the difference between the two[1]. The image shows an example of a sprain of the ankle.

Grades of Injury

A sprain can range from mild (tearing of just a few fibres) to severe (complete rupture of the ligament, leading to joint instability).

The severity of a sprain is graded according to how badly the ligament has been damaged and whether or not the joint has been made unstable. The joint can become unstable when the damaged ligament is no longer able to give it the normal support[1]:

  • Grade I - mild stretching of the ligament without joint instability.
  • Grade II - partial tear (rupture) of the ligament but without joint instability (or with mild instability).
  • Grade III - a severe sprain: complete rupture of the ligament with instability of the joint.

Mild to moderate sprains are treated conservatively and normally heal after 6 weeks.

The below video gives a brief overview of ligament sprains.

[2]

Physiotherapy

Management of ligament sprains includes first aid immediately post-injury (RICE).

Aims are then[3]

  • SLS balance on bosu.jpg
    Prevent abnormal scar tissue formation, joint stiffness, muscle weakness and restore proprioceptive deficits
  • Relieving pain via joint mobility techniques, soft tissue massage, electrotherapy etc
  • Improving scar tissue quality using techniques to guide the direction it forms
  • Loosening or strengthening of injured region with individually prescribed exercises and techniques
  • Improving performance when client returns to sport, work or simply daily life
  • Correct any biomechanical faults that may be affecting movement, technique or predisposing client to injury.

The amount of rehabilitation and the time needed for full recovery after a sprain or strain depend on the severity of the injury and individual rates of healing. Eg a moderate ankle sprain may require 3 to 6 weeks of rehabilitation before a person can return to full activity. A severe sprain can take 8 to 12 months before the ligament is fully healed. Extra care should be taken to avoid re-injury.

See individual page in physiopedia for a particular ligament injury treatment. eg ACL injury, Medial collateral knee injury, Ankle Sprain, Shoulder Instability,

A moderate or severe sprain, particularly of the ankle, may require a hard cast may be applied. Severe sprains may require surgery to repair or reconstruct the torn ligaments. Surgery is usually performed by an orthopaedic surgeon.[1]

Medications

The following medicines may be prescribed[1]

Paracetamol is useful to ease pain (best taken regularly, for a few days or so, rather than every now and then). If the pain is more severe, stronger painkillers such as codeine, is sometimes prescribed.

Non-steroidal anti-inflammatory drugs (NSAIDs) can relieve pain and may also limit inflammation and swelling.

Rub-on (topical) anti-inflammatory painkillers. Some studies suggest that they may be as good as tablets for treating sprains. Other studies suggest they are no better than an embrocation. However, the amount of the medicine that gets into the bloodstream is much less than with tablets, and there is less risk of side-effects.

Common Ligament Injuries

Include[3]:

Cruciate Ligaments.png

Knee Ligament Injuries

Ankle Ligament Injuries

Shoulder Ligament Injuries

Wrist & Hand Ligament Injuries

Spinal Ligament Injuries

Compare to muscle strain

References

  1. 1.0 1.1 1.2 1.3 Patient Sprains and Strains 2018. Available from: https://patient.info/bones-joints-muscles/sports-injuries/sprains-and-strains (last accessed 5.12.2019)
  2. WS Westford Ligament tear Available from: https://www.youtube.com/watch?v=5Gqw9aCMvwE&app=desktop (last accessed 5.12.2019)
  3. 3.0 3.1 Physioworks What to do after a Muscle Strain or Ligament Sprain? Available from: https://physioworks.com.au/treatments-1/what-to-do-after-a-muscle-strain-or-ligament-sprain (last accessed 5.12.2019)