Sprains of the Ankle, Knee and Wrist

What is a sprain?

A sprain happens when a ligament is stretched or torn. A ligament is a strong, fibrous band of rope-like tissue that connects two or more bones at a joint. When you have a sprain, you may have injured one or more ligaments. A sprain is different from a strain, even though sometimes the terms can get used interchangeably. A strain is a stretch, pull or tear of where a muscle attaches to a bone. Think of it as a strain is muscle to bone and a sprain is bone to bone. When you have a sprain, it directly impacts the joint involved. The severity of a sprain can range from the ligament being stretched, partially torn or completely torn. How bad the injury is depends on both the degree of sprain and how many ligaments are involved.

Where do sprains occur?

You can have a sprain in any joint in the body but the most vulnerable spots include those at higher risk of injury from falls and trauma within both the upper and lower parts of the body. The three most common spots for sprains are the ankle, knee and wrist.

• Ankle sprain: This type of sprain typically happens when the foot turns inward as you run, turn or land on the ankle after a jump.
• Knee sprain: Typically, this occurs after a blow to the knee or a fall. Sudden twisting of the knee may result in a sprain.
• Wrist sprain: This sprain often happens when you fall and land on an outstretched hand.

Who is at risk for sprains?

Anyone can be at risk for a sprain. A sprain can happen to both the young and old, as well as the athletic and those doing typical daily activities. You may be at an increased risk if:

• You have a history of sprains
• You are in poor physical condition or are overweight.
• You participate in a lot of physical activity that happens on uneven surfaces.
• You are fatigued — tired muscles are less likely to provide good support.

What causes a sprain?

A sprain is caused by either a direct or indirect injury (trauma) that knocks the joint out of position and overstretches, sometimes tearing the supporting ligaments. Examples of injuries that cause a sprain can include:

• Rolling your ankle — either while running, changing direction or landing from a jump.
• Falling or slipping on a wet surface or uneven ground.
• Taking a blow to the body, including contact sports that cause a direct hit or a shift in balance and falls.

What are the signs and symptoms of sprains?

Signs and symptoms may vary due to severity of injury. They may include:

• Pain.
• Swelling, which can indicate underlying inflammation within the joint or within the soft tissue surrounding the joint.
• Bruising.
• Instability, especially noted on weight bearing joints like the knee or ankle.
• Loss of the ability to move and use the joint.

How is a sprain diagnosed?

A sprain can be diagnosed in several ways, including:

• Through your doctor: Your doctor will take a history and do a physical exam to see if the history and exam are consistent with an injury to the joint which could have injured one or more ligaments. They will check for swelling, range of motion and stability of the joint.
• Through imaging tests: Orthopaedic or Sports Medicine specialists will start with an X-ray to make sure that there is not a broken bone. Although a ligament cannot be seen on an X-ray, it can be important to look at the spacing of the joint and to rule out a fracture. Depending on their exam or your response to initial treatment, higher imaging like an ultrasound or MRI may be required to further evaluate your injury.

Are there different degrees of sprain?

Yes, similar to other injuries, there are different degrees of severity with sprains. The degrees are determined by how badly the ligaments in the ankle or wrist are injured.

• Mild sprain: There is only a little stretching of the ligaments.
• Moderate sprain: There is a combination of stretching and a little tearing of the ligament.
• Severe sprain: There is a complete tear of the ligament.

How are sprains treated?

Your healthcare provider will advise you to follow the PRICE method for the first 24 to 48 hours after the injury. PRICE stands for:

• Protection: Try to immobilize an area of concern or stay off a weight bearing joint to prevent further motion and restore alignment. You may be advised to use a brace/splint or crutches to stay off the injured area.
• Rest: Cut back your regular exercises and activities of daily living. An injury like a sprain requires a change in your normal routine to let the area heal.
• Ice: Apply an ice pack to the injured area for 10 minutes. Do this four to eight times a day. You can use a cold pack, ice bag or plastic bag filled with ice wrapped in a towel. An even better way to ice the area of concern is to use an ice massage method — you can use an ice cube held in a washcloth or put water in a Dixie® cup into the freezer. After the cup is frozen, peel back the top of the cup so it is like a frozen push pop. Use a circular motion or back and forth motion over the area of concern. You only need three to five minutes to ice this because it will penetrate deeply into the area of concern. To avoid frost bite and cold injury, do not apply the ice for longer than 20 minutes at a time. Once you start to feel numb or uncomfortable — you should stop icing.
• Compression: Compression (continuous pressure) of the injured area my help reduce swelling. Using an crepe bandage, you can wrap the affected area always from fingers towards the shoulder (on the upper body) or from your toes to your groin (lower body). This prevents swelling distal (away from the middle of your body) to where the injury is wrapped. A bandage should feel snug, but not so tight it is uncomfortable or cuts off your circulation. You can adjust as needed. An easier way to apply compression from your knee down is with compression stockings. These can be easily purchased online or over-the-counter.
• Elevation: In order to help decrease swelling, keep the injured area elevated on a pillow. You should try to keep the injury above the level of your heart.

Do you ever need surgery for a sprain?

Depending on the joint involved and severity of sprain, sometimes surgery is needed to treat a sprain. If a surgery consult is recommended, they will evaluate the injury, the potential to heal both with and without surgery and make recommendations for the best recovery based on your age, activity level and risk factors involved with surgery.

Will I need to go to physical therapy for a sprain?

Often, physical therapy is recommended after suffering a sprain. This kind of injury can take time to heal and may change the dynamics of the joint. The degree of sprain will determine the steps you will need to take in the recovery process. A physical therapist will work with you to regain strength and mobility in your joint. The therapist will teach you exercises, as well as give you a home exercise program, to prevent the injured joint from becoming stiff. Exercises to build strength and balance (in ankle and knee sprains) will be increased over time until you are back at a pre-injury level of activity. Your physical therapy can help with a return to exercise, sports programs and get the affected joint even stronger than it was to begin with. If you have suffered repeated sprains (such as an ankle sprain) or were immobilized for a while as the area healed (like in a boot or cast), physical therapy will be strongly recommended to reduce the chance of getting injured again.

How can I help prevent sprains?

Though sprains can happen to anyone, there are a few ways you can reduce the risk of a sprain. These tips include:

• Avoid exercising or playing sports when tired or in pain.
• Maintain a healthy weight and well-balanced diet to keep muscles strong.
• Wear shoes that fit properly and be sure any sports equipment is also fitting well.
• Practice safety measures to prevent falls.
• Do stretching exercises daily or prior physical therapy exercises to maintain strength and balance.
• Warm up and stretch before doing any physical activity.

How long does it take to recover from a sprain?

The length of your recovery from a sprain will depend on the severity of your injury. In mild sprains, your recovery may only be a few short weeks. In more severe sprains, it could take up 12 weeks to recover. Surgical repairs of completely torn ligaments will have the longest recovery, the healing and post-operative plan for return to activities would be outlined by your surgeon if you had surgery. Talk to your healthcare provider about the severity of your sprain and a timeline for your recovery.

When should I see a healthcare provider for a sprain?

You should see your healthcare provider if:

• You have a concern about your injury. Sometimes what seems like a mild sprain can take longer than you think to heal. Seeing your doctor can be helpful to answer questions, get a brace, an order for physical therapy or for reassurance.
• You have severe pain and cannot put weight on the injured joint.
• The injured area looks crooked, has lumps and bumps (other than swelling) that you do not see on the uninjured joint. You may notice asymmetry between the affected/injured joint and the normal joint.
• You cannot move the injured joint.
• There is numbness in any part of the injured area.
• You see redness or red streaks spread out from the injury. This is especially a concern if the skin is broken or there could be a possible infection.
• You injure an area that has been injured before.
• You have pain, swelling or redness over a bony part of your foot.