|For information on the prevention and treatment of back sprains, or lumbar sprains, see our Lumbago leaflet.|
The ankle is the most vulnerable joint to the sprain . A sprain is a stretch or tear of one or more ligaments of a joint. Ligaments are the bundles of fibrous tissue bands, very strong and not very extensible, which unite the bones together. They give stability to the joints (see diagram).
Other joints , such as knees , elbows, and wrists , may also experience ligamentous stretching. This type of sprain occurs mostly among athletes.
The pain , the swelling and difficulty moving the joint are the main symptoms of the sprain.
In the majority of cases, the doctor can make the diagnosis after questioning the patient and performing a physical examination. If the doctor suspects a fracture , he offers X-ray radiography. More rarely, a magnetic resonance imaging (MRI) test is undertaken to see the condition of the ligaments.
Degrees of gravity (see diagram)
- Light sprain : a stretch of ligaments, often called sprain . At this point, the joint is still functional;
- Moderate sprain : a stretch of the ligaments accompanied by a partial tear;
- Severe sprain : a complete rupture of the ligament. It is also possible that the tendon is detached from the bone carrying with it a small piece of bone.
Causes of sprain
- Flexion, extension or torsion of the joint beyond its normal range. For example, sprain your ankle while walking on a rough surface;
- Extreme tension on a joint. For example, a football or basketball player who suddenly changes direction;
- A direct blow to a joint;
- Anterior sprains that left a ligament weakened.
In the long term, repeated sprains can cause osteoarthritis, a disease characterized by cartilage degradation, the tissue that covers the end of the bones of all moving joints.
Symptoms of a sprain
- A pain in the joint. Movements are possible;
- A swelling of the joint in the hours or the next day;
- The absence of bruising (blue).
- A pain in the joint. Movements are limited, but possible;
- A swelling of the joint in less than 4 hours;
- A bruise .
- The perception of a crack or a sensation of tearing ;
- A pain often intense, with difficulty moving the joint;
- It is often impossible to put one’s weight on the injured limb;
- A swelling rapidly, in minutes;
- A bruise .
People at risk for sprain
- Professional athletes, amateur athletes and people who are following a physical training program;
- People who have had a sprain (or other joint injuries)
- People who are overweight or in poor physical condition;
- Old people. Reflexes are slower as you get older, so that stumbles – and sprains – increase in frequency with age.
- A lack of warm-up
- Insufficient or poorly conducted training
- Muscular fatigue The tension on the joint is greater when the muscles are tired;
- Inappropriate equipment (for example, wearing walking shoes rather than booties during a hike in rough terrain);
- A playing area in poor condition.
Prevention of a sprain
|Basic preventive measures|
|Measures to prevent recurrence|
Medical treatment of a sprain
Most people can return to their usual activities within 6 weeks.
In case of moderate or severe sprain, it is not uncommon for sequelae , such as pain or instability of the ankle. The risk of re-offending is also higher.
During the 3 days (72 hours) following the trauma, the treatment of the sprain is based on the RGCÉprinciple (rest, ice, compression, elevation). The purpose of this treatment is to stop the bleeding typical of moderate and severe sprains.
|Any application of heat and any massage are formally prohibited . The massage, and even the palpation, may increase the pain, aggravate the lesions and cause haemorrhage.|
- Rest . If the pain is severe, the injured limb should be rested, but not more than 48 to 72 hours. In the vast majority of cases, longer rest is not desirable because the use of the joint promotes healing. Pain is the best guide: just put the weight you can endure without too much pain and increase this gradually. If necessary, use crutches to reduce pain during walking when sprained knee or ankle. In some cases, it is best to immobilize the joint (see below).
Ice . Apply ice as soon as possible to minimize swelling (see tips below). Ice relieves pain, reduces inflammation and reduces swelling by tightening blood vessels. It can also reduce bleeding if ligaments have been torn.
- Compression . Wrap the affected area with an elastic bandage to reduce swelling and bruising and to support injured ligaments. Do not squeeze too hard not to cut blood circulation.
- Elevation . Keep the injured limb in an elevated position. The injured limb must be raised 10 cm higher than the heart (sitting on a stool is not effective). If possible, maintain elevation for 2 to 3 hours each day until pain and swelling subside. Elevation promotes blood flow back into the veins and limits the accumulation of inflammation fluid around the injured area.
|Tips for applying ice
The ice must be applied to fit the shape of the injured area. It should be placed in a bandaged bag, not too tight to stop blood flow, but enough to allow compression to stop bleeding. A wet towel can be placed between the bag and the skin.
Leave the ice in place for 10 to 12 minutes . There is no point in letting it go longer, because the ice only tightens the blood vessels for about 10 minutes, after which they “re-in”.
Frequency. Repeat every hour or every two hours, keeping the joint continuously elevated. This procedure must be followed several times during the first 2 days after an injury. Then continue applying ice 3 to 4 times a day, until the pain is gone, at rest and exercise.
Analgesic medicines such as acetaminophen (Tylenol, Atasol) can help relieve pain . Drugs anti-inflammatory , such as ibuprofen (Advil, Motrin), are conventionally used in the acute phase (for 2 or 3 days) in addition to compressive and applying ice. They help relieve the pain. However, there is no evidence that they accelerate healing. The inflammatory reaction is part of the process of tissue repair. People who take anti-inflammatories should pay attention to their effects on the stomach, which can be major (stomach pain, gastrointestinal bleeding, ulcers, etc.). Follow the dosage carefully.
If the elbow or shoulder is touched, support the arm with a sling , but avoid immobilizing it for more than 2 or 3 days , as these joints become ankylosis very quickly. A moderate or severe sprain may require the use of an orthosis in order not to aggravate the lesion. The doctor can prescribe one. The orthosis limits movements in the axis of the injured ligaments, but allows other movements. There are some for all types of joints. According to a meta-analysis , the use of a laced ankle would allow faster resorption of ankle swelling in the short term than the elastic bandage or “taping”. In case of serious sprain, we can consider the immobilization with a plaster for ten days.
It is sometimes considered in case of severe sprains , especially in people who use the damaged joint intensively, such as athletes, or in case of persistent instability of the joint.
The resumption of the usual activities is done in a progressive way. Some exercises proprioception, exercises with elastic bands and on balance boards promote recovery and reduce the risk of recurrence. They help the ligaments regain their full capacity, reduce stiffness and strengthen the musculature which has often atrophied by the limitation of activities. A rehabilitation therapist (physiotherapist or sports physiotherapist) is able to suggest such adapted exercises to practice at home.
The treatments physiotherapy (massage, ultrasound, mobilizations, etc.) may be part of treatment, but usually are not essential to recover well.