Sprain or strain? How to recognise and treat them

What should I do?

Although most people has been the victim of at least one sprain or strain during their lifetime, few understand the difference between these two types of injury. Stretching is commonly defined as "muscle tearing" and, as the name suggests, this occurs when the muscle is over worked due to excessive weight or physical exercise. In this case, spasms, contractions or swelling of the muscle fibres may occur. Muscle strain can produce stinging when you try to use the muscle, soreness or a dull, throbbing soreness in the affected area. When contractions or spasms occur, the pain can be continuous and intense. The most severe symptoms associated with stretching disappear after a week, but sometimes leave mild discomfort that can last up to a month.

    Twisting, contrary to what many people believe, are not the result of a muscle trauma. In this case, in fact, the damage is borne by the ligament, that is, the fibrous connective tissue strip that connects the bone to the joint capsule. When a ligament is hyper-stressed, it can tear or stretch beyond its length, and at the time of the trauma, you may even hear the distinctive sound produced by the laceration. Not surprisingly, the distension causes and immediate sharp pain and, once you've got over the initial shock of the pain, swelling, soreness and sensitivity at the extremities take over. In most cases, loading weights onto joints affected like this is out of the question. With appropriate treatment, the swelling disappears after about a week but the pain can last for several weeks, and the joint usually remains stiff for several months.

   Most of the stretching and distortion responds well to rest and domiciliary care, however it's a good idea to check carefully for any of the signs that may need medical attention. If the pain is intolerable and you can't move the joint, the bone may be fractured. In these cases, rather than going back to bed, you should contact your GP or an A & E department. Other signs that should be monitored are a bluish articular coloration or particularly significant oedema that doesn't diminish within a few days.

Reducing the risk

Although sprains and strains are fairly common events, you can decrease the risk of injury to muscles or ligaments. First of all, you need to carry out regular physical exercise: people who don't use their muscle and bones regularly are much more likely to be injured. Secondly, it is essential to warm your muscles up before embarking on physical activity by stretching and starting to move gently. Finally, you should always use common sense: don't lift heavy objects on your own, and don't take part in activities that might produce injuries.

Symptoms of strains

• Painful stitches when using the muscle
• Dull induration and pulsation on resting
• Muscle spasms or cramps
• Swelling

Symptoms of twisting

• Extremely acute pain at the time of trauma, which then changes into a dull ache
• Swelling
• Blueish colour of the affected joint (index of serious injury)

Main causes

• Over use of muscles or ligaments, usually as a result of lifting heavy weights, heavy exercise or accidents.
• Imbalances between antagonist muscle pairs
• Nutritional deficiencies that make them more susceptible to trauma

Emergency measures for sprains and strains

When you suspect a strain or a sprain, it is important to act quickly. The simple first aid techniques described below, if implemented immediately after the trauma, allow more rapid healing and can reduce the level and duration of pain considerably .

1.  If you are suffering from significant pain, swelling and a bluish colour of the site concerned, or any of these symptoms, you should seek medical attention immediately. Use caution, particularly in the case of traumatic injuries to the wrist or ankle: these parts of the body are rather delicate and subject to fracture.
2. To reduce swelling and relieve pain, apply an artificial ice bag or a cold compress to the injured area. In the absence of adequate means, it is possible to fill a plastic bag with ice cubes and wrap in a clean towel, or use a bag of frozen food. The important thing is that the ice should not come into direct contact with the skin, otherwise you'll add a freezing injury to the twisting or stretching. Keep the compress in place for twenty minutes, then wait ten minutes before reapplying it.
3. Raise the affected areas as much as possible, so that they are positioned higher than the heart. This allows the blood to drain from the trauma site and reduces the swelling.
4. Hold the raised portion, and continue to apply ice packs for one or two days after the trauma, then alternate hot and cold pack applications. At this point, it is no longer necessary to use cold packs at the same frequency as you did in the first hour and half after the trauma, but occasionally, and according to need. If after one or two days, the swelling has not gone down significantly, consult a doctor.

Treatment

Maybe it's hard to believe that diet can play a significant role in the process of healing a traumatic injury, but appropriate nutritional choices in the weeks after a sprain or a strain can indeed speed up recovery and reduce pain.

Recommended foods:

To rebuild strong and elastic muscles and ligaments, it is important to eat lean proteins. To this end, it is advisable to consume reasonable quantities of good quality chicken, turkey and fish and to add beans to the meal.

   Traumas and injuries can lead to the formation of free radicals, or unstable molecules believed to be responsible for numerous ailments. You can fight free radicals thanks to the antioxidants found in fruit and vegetables with a strong colour.

   As vitamin C helps to reduce swelling and repair the tissues, the consumption of citrus fruits as a light dessert is recommended .

Investigation techniques

The following tests can help determine the possible causes of a slow recovery from a sprain or a strain:

• Intestinal permeability - urinalysis
• Liver function tests - urinalysis
• Analysis of vitamins and minerals (especially magnesium, vitamin C, iron) - blood tests

Foods to avoid:

   As a result of a twist or stretch, you will have to stay home, so its easy for this situation to depress your mood; however, you'll have to resist the temptation to seek consolation by eating unhealthy foods: ready-made, pre-packed, fried foods and foods with a high salt content will only aggravate the inflammation and swelling.

Several double-blind studies have shown that proteolytic enzymes, like bromelain, papain, trypsin and chimotrypsin, accelerate recovery from trauma and sports injuries.

Seven key requirements - Sprains and strains

Bromelain

Take 500 mg three times a day in the interval between meals. It is recommended that you use a standardised product, titrated to 2,000 MCU / 1,000 mg, or 1,200 GDU / 1,000 mg. Bromelain has a natural anti-inflammatory effect, and products based on proteolytic enzymes (chimotripsin, trypsin, fungal derivative proteases) also produce the same post-release results.

Methylsulphonylmethane (MSM)

Take 1,000 mg three to four times a day. This supplement exerts a powerful anti-inflammatory effect and is a natural source of sulphur, which promotes the health of tendons and ligaments.

Vitamin C

Take 1,000 mg two to three times a day. Vitamin C is necessary for the formation of connective tissue and has anti-inflammatory properties.

Dimethyl sulfoxide (DMSO)

See your doctor for a prescription of this painkilling substance for topical use.

Boswellia (Boswellia serrata)

Take 1,200 to 1,500 mg of a standardised extract with a boswellic acid content of 60-65% three times a day. This plant has a powerful anti-inflammatory effect.

Oil of Arnica (Arnica montana)

Apply the preparation on the injured part twice a day. This vegetable extraction oil reduces pain, haematoma and swelling. Do not apply to broken skin.

Essential fatty acids

Take 1 to 2 tablespoons of flaxseed oil or 5 g of fish oil per day. Alternatively, obtain a composite formula of Omega-3, 6 and 9 fatty acids. Essential fatty acids reduce inflammation and promote tissue repair.

References:

Blonstein, J. L., «Oral enzyme tablets in the treatment of boxing injuries», Practitioner, n. 198, 1967, p.547 Buck, J. E., Phillips, N., «Trial of Chymoral in professional footballers», British Journal of Clinical Practice, n. 24, 1970, pp. 375-377

Deitrick, R. E., «Oral proteolytic enzymes in the treatment of athletic injuries: A double-blind study», Pennsylvania Mediacl Journal, 1965, pp. 35-37

Holt, H. T., «Carica papaya as ancillary therapy for athletic injuries», Current Therapeutics Research, n. 11, 1969, pp. 621-624

Rathgeber, W. F., «The use of proteolytic enzymes (Chymoral) in sporting injuries», South African Medical Journal, n. 45, 1971, pp. 181-183

Tsomides, J., Goldberg, R. I., «Controlled evaluation of oral chymotrypsin-trypsin treatment of injuries to the head and face», linical Medicine, n. 76(11), 1969, p.40