Esguinces y torceduras
A sprain is an injury to the tissue that connects two bones together, while a strain is an injury to a muscle or the tissue that attaches a muscle to a bone.
Not all types of sprains and strains are well documented, but to give a subset example: among the 1 million ankle injuries per year, about 85% of them are sprains.
Many people get sprains and strains during their lifetime. Insufficient warm up, poor conditioning, and participation in contact sports are among the major contributing factors.
Most heal well, but more serious injuries can result in chronic joint or muscle pain, swelling, and an unstable joint.
Symptoms
What is a sprain?
A sprain is defined as damage to a ligament–the fibrous connective tissue holding a joint together–when the joint is forcefully taken out of its normal range of motion.
The most commonly sprained joints are the ankle, knee, and wrist. Typical symptoms are pain, swelling, and bruising.
What is a strain?
A strain is an injury to a muscle or tendon due to overstretching, especially when the muscle is being actively contracted. The injury typically occurs at the junction of the muscle and tendon where forces are greatest. Symptoms include pain with muscular contraction and swelling. With more severe injury, bruising can also occur.
Due to their particular anatomy, the hamstring and quadriceps are the most commonly injured muscles.
How is severity graded?
Strains and sprains are graded on a three point scale.
Grade 1 injuries, the mildest, occur when tissue fibers are stretched and undergo microscopic damage. These injuries can produce pain and swelling, but rarely cause bruising.
Grade 2 injuries involve a partial tear of tissue fibers. These injuries also produce pain, swelling, and bruising.
Grade 3 injuries, the most severe, represent those with a full tear of the affected muscle or ligament. In these cases, there is significant swelling, bruising, and weakness of the affected limb or joint.
Treatment
If I think I think I have a sprain or strain, what should I do immediately?
Current recommendations still support using RICE (rest, ice, compression and elevation) for three-to-seven days to limit swelling and pain. The typical approach is applying ice to the injury for 20 minutes every two hours for three days.
A recent study, however, showed that using a 10 minute on / 10 minute off / 10 minute on regimen every two hours decreased pain from ankle sprains more than the traditional approach. These initial steps diminish swelling and pain, leading to faster recovery.
Is it okay to walk on a sprained ankle?
Yes. In the past, prolonged rest was often recommended. But now, evidence suggests that weight bearing as soon as pain allows–in addition to using an air cast and elastic bandage–contributes to faster recovery.
When should someone go in to have an injury examined?
Injuries with significant swelling, bruising, pain, or disability should undergo evaluation by a medical provider as soon as possible to determine the extent of injury.
How does a doctor treat sprains and strains?
There are a variety of modalities available to treat sprains and strains and to help people regain the movement, strength, and stability of the affected joint or muscle. The type or severity of the injury–along with the stage of recovery–dictate the optimal treatment approach.
In the acute stage, both strains and sprains respond favorably to a short course (three-to-seven days) of anti-inflammatory medications such as Advil, Aleve, and Motrin. Sprains also benefit from bracing in order to support the injured ligament and stabilize the joint. While mild strains may not need bracing, healing is helped by avoiding excessive loads on injured muscle or tendon fibers.
After the acute phase of the injury (usually three-to-seven days, depending on the severity) other approaches can speed recovery and reduce the risk of reinjury. Of these, strengthening, flexibility, and proprioceptive training have consistently been shown to improve recovery and decrease the risk of reinjury in both strains and sprains.
What techniques tend to be used by physical therapists?
There are a variety of techniques used by physical therapists to address different aspects of recovery. These techniques include manual therapy, strength training, proprioceptive (balance) training, taping, needling, and acupuncture, to name a few. The physical therapist evaluates each case and develops a treatment regimen based on their findings.
Usually, strength and balance training form the foundation of most treatment plans, but other treatment modalities can be used to decrease swelling, muscle spasm, and to address imbalances that may have contributed to the injury.
Are there any specific foods or supplements that can support healing?
Although many sites and articles claim that certain supplements can help to heal strains and sprains, no studies have shown any direct benefit. However, although extra supplements cannot speed healing, making sure that you have a healthy diet and an appropriate amount of sleep will prevent any delay in the normal healing process.
How long do sprains and strains take to heal and what influences the timeline?
A few factors generally contribute to healing time.
- Type of injury: Those involving more tissue damage and bleeding generally take longer to heal and rehabilitate.
- Location of injury: One study, for example, showed that hamstring strains closer to the pelvic insertion took longer to heal.
- Type of post-injury care: Ankle sprains that were immobilized with an air cast and an elastic bandage recovered faster than those that were immobilized using an elastic bandage by itself, for instance.
- Proper rehabilitation: This is especially important in those patients who would like to return to sports. As an example, ankle sprains that do not receive strength and balance training are at higher risk for reinjury. Moreover, muscle strains appear to benefit from added agility and trunk stabilization exercises.
Can sprains and strains fully heal?
The likelihood of being able to return to previous levels of activity depends a great deal on the severity of the injury and the level of activity desired.
In the vast majority of cases, with proper care and rehabilitation, grade 1 and 2 injuries can return to previous levels of activity. Grade 3 injuries, however, require more intervention–even surgery–in order to regain previous levels of activity.
Prevention
What are the risk factors that make people more susceptible to sprains and strains?
Risk factors for sprains and strains can be broken down into two categories: intrinsic and extrinsic factors. Intrinsic factors include anatomical structure, tissue type, and a history of previous injury. Extrinsic factors describe the environment or stresses that the joint or muscle experiences.
Several intrinsic factors can predispose a muscle to injury. Muscles that are particularly prone to harm include those that cross two joints, such as the hamstring or quadriceps; those with more type II (fast twitch) fibers (those that produce quick, powerful movements); and those with a more complex muscle-tendinous architecture, like the hamstring and anything with a previous history of injury.
Extrinsic risk factors for muscle strain include inadequate muscle warm-up, muscle fatigue, and eccentric exercises that lengthen the muscle under force, such as lowering the weight slowly after a bicep curl.
Most of the research regarding sprains focuses on the ankle, the most commonly sprained joint. Study results are mixed, but five intrinsic risk factors seem to play a role in ankle injury: inadequate strength, tight calves, poor proprioception, poor balance, and a history of a previous sprain.
The extrinsic risk factors for ankle sprains include the type of sport, the number of players, and the competitive level. Sports with the highest risk of ankle sprain are indoor volleyball, rock climbing, and field sports such as soccer and football. Sports with more players and those played at a higher competitive level also increase the risk of injury.
What is the best approach to prevent a sprain or strain?
Evidence pointing to a single, best way to avoid strains and sprains is either lacking or contradictory. The many variables leading to injuries and the specific requirements for different activities make it difficult to design studies that come to a generalizable conclusion.
There is some evidence, however, pointing to some sport-specific strategies for injury avoidance. For example, contrary to popular belief, static stretching prior to exercise does not appear to decrease the risk of injury in everyone. A better approach is to develop a warm-up that includes sports-specific dynamic stretching.
Luego, se pueden incluir estiramientos estáticos para aquellos deportes que requieren flexibilidad, como la gimnasia y el baile. Para los deportes que requieren movimientos explosivos, como correr y saltar, el estiramiento estático puede ser perjudicial.
La capacitación en tablas de equilibrio es otra estrategia que puede reducir el riesgo de lesiones relacionadas con el deporte, aunque es posible que esto no se aplique a todos los deportes.
Por último, los atletas que participan en deportes como el fútbol, el fútbol y el snowboard puede reducir el riesgo de esguinces de tobillo mediante el uso de soportes externos para los tobillos.
Enlaces útiles
Ejercicios de tabla oscilante (Livestrong)
Una lista de estiramientos dinámicos (Livestrong)
Una buena explicación de la diferencia entre estiramientos estáticos y dinámicos (Livestrong)
Un artículo de revisión sobre la prevención de lesiones deportivas (JAMA)
Conéctese con nuestros médicos
Andrew Cunningham, MD, y Steven Winiarski, DO, son miembros del equipo clínico de Galileo. Póngase en contacto con uno de nuestros médicos sobre esguinces y distensiones o sobre cualquiera de las muchas otras afecciones que tratamos.