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Ligament Sprains

A strain is an injury to muscle with damage that is caused by over-stretching of muscle tissue.

A sprain is an injury to ligaments and joint that is caused by being stretched beyond their normal capacity and possibly torn.

Ligament Sprains

What is a Ligament Sprain?

A sprain is an injury to ligaments that is caused by being stretched beyond their normal capacity and possibly torn.

A joint is surrounded by ligaments. Ligaments are the strong, flexible bands of fibrous tissue that link bones together.  They contain a lot of nerve endings and so that your body knows what each joint is doing all the time. This is called proprioception.

Proprioception is the mechanism by which nerve receptors in skin, muscle, ligament and joint tissue relay information to the brain about body position sense, where this information is quickly processed and movement strategies are formulated and executed using nerve signals to muscles.

This mechanism can help you ‘catch yourself” when you are about to turn your ankle.  In the unstable ankle joint these receptors may have been damaged directly during a joint sprain. This impaired proprioceptive ability may, therefore, lead to a delay in protective muscle activity and the resultant loss of postural awareness and stability around a joint. This may explain why recurrent ankle sprains are so common.

When we ignore warning signs from these nerve receptors, we risk injury.

Sprains typically occur when the joint is overextended. This can cause over stretching of the ligament, tear or rupture the ligament

After any sprain, proper rehabilitation is a must; especially when the injury has been severe. After acute treatment, a rehabilitation program is critical in speeding recovery of the joint. Lack of rehabilitation can often delay return to normal function for months.

Lack of stability of a joint due to poor muscle strength also allows too much movement to occur at the joints (hypermobility).

Hypermobility causes changes in your joints. It tries to stop the movement with the growth of small bony elements called bony spurs (osteophytes). Unfortunately, the bone spurs sometimes pinch nerve structures and cause pain. This is the start of joint degeneration otherwise known as osteoarthritis.

Symptoms

Pain, swelling and bruising.  Depending on the degree of sprain this may be instant and acute or gradual over several hours.  There is reduced ability to move the joint.  If the ligament ruptures, you may hear a popping sound.

Depending on their severity, ligament sprains are categorised into Grades 1, 2 or 3:

Grade 1 Sprain:

There is damage to individual ligament fibres (less than 5% of fibres). This is a mild sprain which requires 2 to 3 weeks rest.

Grade 2 Sprain:

There is more extensive damage, with more muscle fibres involved, but the muscle is not completely ruptured. There is extensive visible bleeding. The rest period required is usually between 3 and 6 weeks.

Grade 3 Sprain:

This is a complete rupture of a ligament. In a sports person this will usually require surgery to repair the ligament. The rehabilitation time is around 3 months.

Avulsion fracture: This is where the ligament is torn from the bone.  It is commonest in the ankle.  It requires immobilisation with plaster cast.

How does a damaged ligament heal?

The healing process of a ligament injury begins with an inflammatory response which can last for three to five days. This is a crucial time during which rest and protection of the injured part is vital in order to prevent any further damage. During the inflammatory reaction the body produces chemicals and cells which remove dead ligament fibres and start the repair process. The repair process consists of three stages:

REGENERATION: New ligament fibres grow from special cells within the ligament.

FORMATION OF SCAR TISSUE: There is bleeding in the gap between the torn ligament fibre ends, and from this blood matrix, or scaffold, is formed to anchor the two ends together.

MATURATION OF THE SCAR TISSUE: The collagen fibres which make up the scar tissue become aligned along lines of external stress and are able to withstand more force

Treatment

Acute joint sprain: Follow R.I.C.E protocol. Stop the activity, rest in a comfortable position, preferably lying down and apply ice or a cold pack for 10 minutes every hour for 6 hours to reduce internal bruising to the muscle. The nearby muscles may tend to spasm for the first two or three days after injury. Alternate hot and cold compresses can help to ease the spasms. Avoid over-working the back for several days but do try to continue with as near to normal activities particularly walking to keep the area actively healing.

It is important to keep the region warm to relieve back pain and muscle spasm, but preferably using clothing, a pad or pillow avoiding hot water bottles or similar as these tend to cause congestion of the area.

Taping or using a joint support will help protect the joint and ligaments from further injury and allow normal activities to continue as much as possible.

Rest, non-steroidal anti-inflammatory (NSAIDs) drugs e.g. paracetamol, aspirin or ibuprofen should help settle the problem in a week or two.

Massage may help to ease the pain but care should be taken not to relax the surrounding muscles too quickly as this may lead to more severe reflex spasms as the back is attempting to protect the joints form further injury.  

Gentle osteopathic mobilisations help to clear the inflammation from the joints and ease the tenderness.  If the joint is ‘nipped’ manipulation may be used to free the joint.

Mild to moderate joint sprain: This is usually noticed the next day when there may be significant pain and stiffness on getting up in the morning. A warm shower or bath, especially with Epsom salts will help to ease the stiffness. See the Hydrotherapy page. Again refrain from the offending activity but do keep on the move.

Osteopathic manipulation of the joint with a controlled thrust will reduce muscle spasm, free off nerves, open up the facet joint and break down early scar tissue, which may limit movement.

Taping or using a joint support will help protect the joint and ligaments from further injury and allow normal activities to continue as much as possible.

An error most people make is to use prolonged immobilization. This usually leads to muscle atrophy and a stiff joint. The components of an effective rehabilitation for all sprain injuries include increasing range of motion and progressive muscle strengthening exercise.