Sprain vs. strain... is there a difference? Does it really matter?
I have so often heard from my patients when they first enter my office seeking care that they have sprained their lower backs when in reality what they suffered was a lower back strain.
A sprain is an injury involving a
tearing of a ligament.
Sprains are less common than strains. They are usually the result of an obvious traumatic incident where the ligament is pulled beyond its limit. The most common sprain is a lateral ankle sprain usually from rolling the foot inward.
The ligaments are usually what holds your joints together and are very strong, tough fibers. So a lower back sprain would involve some amount of extreme force in order to disrupt the lower back ligaments.
A strain involves some degree of muscle tear. Unlike sprains it is rather common and is often the cause of lower back pain.
A muscle tear is the result of muscle fiber(s) exceeding their normal length due to forces exerted on it. It can also be caused by an overload where the load exceeds the muscle's contracted strength.
You see the former when a weight lifter takes the weights to far beyond the normal length of the muscle as in a hamstring pull from doing dead-lifts.
The latter injury action occurs for example when you attempt to lift a heavy object while twisting and turning the lower back at the same time. This is a common occupational injury or one that occurs from doing heavy yard work.
When a muscle tears it can be a micro-tear or a macro-tear. Micro-tearing involves tiny muscle fibers whereas macro-tearing will involve large groups of fibers or even the entire muscle.
In either case the muscle will bleed and there is reactive spasm, inflammation and pain.
The spasm is your body's attempt to splint the injured area and thus prevent further damage.
Pain is another means of keeping you immobilized so you do not use the muscle in a manner that will further disrupt the tear and delay proper healing.
Inflammation is needed to clean out the congealed blood and damaged tissue and allow for repair and healing.
You know what happens when you cut your finger or have a surgical incision. You have tenderness around the cut, redness, inflammation and swelling. This is all normal and necessary for proper healing and repair.
Now envision the same reaction and healing process occurring on the inside to a torn muscle and ligament.
A sprain will usually involve more ligament fibers and result in severe immediate pain. Whereas, a strain usually involves a few muscle fibers and symptoms can often be delayed several hours and can have a wide range of symptom severity.
A sprain will not cause spasm unless it is accompanied with some muscle strain as well.
So the difference essentially is the type of tissue that is injured or torn. Sprain is ligament tear... strain is muscle tear.
Immediate treatment is the same for either injury. Just think of PRICE.
It is very important to avoid joint movement with a sprain to allow the torn tissue to mend without disrupting more fibers and risking a “sloppy” joint.
Strained muscle will mend easier and return to more normal function than a ligament tear.
It will also take longer for a sprain to heal than it will a strain.
With either injury early treatment and proper rehabilitation is essential to ensure a more complete healing with less residual aftereffects.