Sprain vs. Strain

In all aspects of my practice, I see many, many kinds of sprains/strains.  I am also frequently consulted by adjuster and attorneys to assist in determining  the severity of an injury, the treatment plan, and the reported mechanism of injury.

Recently, I spoke to a group of new adjusters at a lunch and learn about the basics of strains and sprains.

Here are the highlights!

Sprains – injuries to ligaments, the fibrous bands that connect bones to bones and stabilize joints. Example: the ligaments in the knee. 

Strains – injuries to muscles or to tendons, the tough, fibrous bands that connect muscles to bones.

These injuries can be acute or chronic. Chronic injuries are gradual and build from overuse or repetitive stress.

Common causes

Indirect /direct trauma, an overstretch of the area, etc.  Typically the injuries happen when an individual lands wrong (plants a foot wrong, slip and fall, lands with an outstretched arm, etc) or uses poor body mechanics.

Common Signs of sprain

  • Swelling, pain, redness, weakness and/or muscle spasm and bruising.
  • Mild sprain/Grade 1= mild pain with no loosening of the joint. No tear of the ligament.
  • Moderate sprain/ Grade 2= partial tear of the ligament. Possible joint instability. Swelling and moderate pain.
  • Severe sprain/ Grade 3= complete tear/rupture of the ligament. Significant pain at the time of the injury. Swelling, weakness and usually a nonfunctioning joint.

Common Signs of strain

  • Swelling, pain, redness, weakness and/or muscle spasm, inflammation, cramping.
  • Mild strain= mild pain with a “stretching”  or pull of the muscle/tendon.
  • Moderate strain= Swelling and moderate pain with an overstretch of the tissue, slight tear.
  • Severe strain= Partial/complete tear, severe pain, limited function and /or incapacitating result.


R             rest

I               ice

C             compression

E              elevation

Mild to moderate tissue injuries will recover in a few weeks with possible physical therapy. Severe injuries can require surgery, immobilization and at times months to heal/recover. 

Typical Injures

  • Acute ankle sprain
  • Chronic wrist sprain
  • Acute low back strain secondary to a lifting injury
  • Biceps tendon rupture would be a 3rd degree strain; the muscle belly/tendon is pulled completely from the attachment point
  • Lateral/medial epicondylitis