Sprain Versus Strain: What's the Difference?

Written by Dr. Joseph Mercola

sprain or strain

Story at-a-glance -

  • Although the symptoms are similar, strains involve muscles and tendons that anchor your muscle to bone, while sprains are injuries to your ligaments, supporting bone-to-bone connections
  • Sprains often occur as the result of an acute accident or injury, while strains may be the result of either an acute event or after chronic repetitive injury, such as to your lower back
  • Many sprains and strains may be successfully treated at home with the RICE protocol and using astaxanthin, bromelain, ginger and curcumin or arnica to help control pain prior to engaging in a strengthening and flexibility program to return to your former level of activity
  • You may help reduce your risk of injury by wearing proper equipment for your sport, staying in shape to play your sport instead of using your sport to stay in shape, maintaining good strength and flexibility in your joints and warming up prior to working out

Having been an avid exerciser for nearly five decades, there is no doubt in my mind a comprehensive fitness routine is essential for optimal health. Fitness is a life-long journey. One of my favorite forms of exercise is high-intensity interval training (HIIT), not only because it takes less time but also because it makes my mitochondria work harder and ensures my body is primed to resist disease.

Many gravitate toward exercise as it brings welcome changes in physical appearance, such as weight loss, toned muscles and less body fat. But despite these benefits, and more, according to the U.S. Centers for Disease Control and Prevention, close to 80 percent of U.S. adults do not get enough exercise.1

In their survey, they found only 20 percent of Americans get the recommended amount of at least 2.5 hours of moderate-intensity aerobic exercise each week and strength training twice a week.

Sprains and strains are common injuries that can occur during a workout or just walking down the street. The most common type is an ankle sprain, occurring more frequently in women than men.2 Treatment in the emergency department accounts for a significant amount of health care charges in the U.S.3

Being able to recognize the difference between a sprain and a strain and the severity of the injury may help you determine if at-home treatment is appropriate. Knowing how they occur may also help you prevent an injury by taking specific precautions.

Strain Your Muscles and Tendons, Sprain Your Ligaments

Sprains and strains are not uncommon injuries in those who enjoy moving and working out. While they share similar signs and symptoms, they involve different parts of your body.4 In both instances, damage is done to the soft tissue, including ligaments, tendons and muscles. The difference is which soft tissue has been affected — ligaments or tendons?

Ligaments are tough bands of elastic tissue connecting bone to bone and giving your joints support while limiting movement.5 The most common type of injuries to ligaments occurs during sporting activities. Although similar, tendons are connective tissue attaching muscles to other parts of the body, usually bones.6 They have one of the highest soft tissue tensile strength found in your body, necessary to withstand stresses generated by muscle contraction.

During a sprain, ligaments connecting two bones together are stretched or torn. The most common location for a sprain is in the ankle. During a strain, there is stretching or tearing of muscle or tendon, occurring more often in the lower back and hamstring muscles located in the back of your thigh.

What Causes a Sprain or a Strain?

Strains and sprains can happen during sporting activities, from an accident or during everyday activities when preventive measures have not been taken or your body is unable to withstand the forces placed on it. Many things can cause a sprain, such as falling, twisting or getting hit with a force that moves your joint out of its normal position.

For instance, falling and landing on your arm, twisting your knee or rolling your ankle so you fall to the side of your foot may each result in a sprain. These motions cause the ligaments around your joint to stretch or tear.7

Other common circumstances causing ligament sprains include walking or exercising on uneven surfaces, pivoting during an athletic activity, or landing on an outstretched hand during a fall may result in a wrist sprain. Your thumb may sustain an injury during skiing or overextension playing racquet sports, such as tennis.8

Ligaments are anchored to bone on each side of the joint. A sprain happens suddenly and most often in an area right around the joint as the ligament is stretched to far or is torn.9 A strain happens when you pull or twist a muscle or tendon and can occur suddenly or develop over days and weeks of lifting heavy objects the wrong way or overstressing muscles.

You may suffer chronic strains much like a chronic overuse injury, when you place abnormal forces on your joint to perform a repetitive motion.10 Some repetitive movements increasing your risk of chronic strain include gymnastics, tennis, rowing and golf.11

What Increases Your Risk of a Sprain or Strain?

Muscles have a large number of small fiber bundles called fascicles. Individual fibers are cross-linked so they slide inside the fascicle. Near the end of each muscle these fibers turn into tendon and then attach to bone. A strain happens when damage develops in an overstretched muscle or tendon, pulling the fibers apart and losing the ability to adequately contract.12 Several factors may contribute to an increased risk of developing a strain or experiencing a sprain, including:13

  • Lack of conditioning — This can leave your muscles weak and more likely to sustain an injury from low degrees of force.
  • Fatigue — Muscles that have been worked to fatigue are less likely to provide good support to the joints.
  • Tight muscles — Improper warmup or lack of stretching reduces range of motion in the joint and makes your muscles prone to trauma and tears. Properly warming up before vigorous activity helps to loosen your muscles and increases your range of motion.
  • Environmental conditions — Slippery, uneven surfaces may increase your risk of injury, such as running on the side of a canted (sloped) road may increase your risk of muscle strain as one leg is chronically hitting the road lower than the other leg due to the road slope.
  • Improper equipment — Ill-fitting or poorly maintained equipment, including footwear, can contribute to your risk of a sprain or a strain.

How to Tell the Difference Between Sprain and Strain at Home

To determine the difference, your physician will ask about the injury, examine the area and potentially order an X-ray to determine you don't have a broken bone.14 Mild sprains and strains can be treated at home, but the circumstances causing these injuries may also result in a fracture.15 You should see your physician if:16

You can't walk more than four steps without significant pain

The injured area looks crooked or has lumps you don't see on the uninjured joint

You cannot move the affected joint

You have numbness in any area near the injury

You have pain directly over bones in an injured joint

You see redness or red streaks spreading from the injury

You have reinjured an area that's been injured several times

You have pain, redness or swelling over a bony area

The symptoms of a strain and sprain are very similar; however, the history of the event is likely very different.17

Strain

Swelling

Bruising

Limited mobility

Pain or tenderness

Muscle spasms or cramping

Muscle weakness

Sprain

Limited mobility

Pain

Swelling

Bruising

Inability to bear weight

There may be a "popping" sensation when the injury happens

Although you might be interested in determining the difference at home, generally speaking, the treatments are pretty similar. This means it isn't important to know exactly which one you're treating. However, it is important to rule out severe tears and broken bones as these treatments are different from the first aid you'll apply at home for a Grade 1 or Grade 2 sprain or strain.

Grade Your Injury and Estimate Your Recovery Time

Sprains and strains are classified using grades to indicate the severity of the injury. The higher the grade, the more painful and severe the injury to your muscles, ligaments or tendons. With a Grade 1 strain or sprain, you may experience very slight tearing or overstretching and have very little inflammation.

Grade 2 is slightly more severe and Grade 3 is a complete rupture of the tendon or the ligament. With a Grade 3 injury you're likely to experience a high level of pain that doesn't get better and makes tolerating walking or weight-bearing nearly impossible. In a side-by-side comparison of the descriptions, you'll notice the similarities between the grades of a sprain and a strain:18,19

Strain Grades Sprain Grades

Grade 1: Stretching of a few of the muscle fibers.

Grade 1: Fibers of the ligament are stretched but not torn.

Grade 2: Muscle fibers are damaged or torn.

Grade 2: Ligament is partially torn.

Grade 3: Complete rupture of the muscle, often accompanied by large areas of bruising.

Grade 3: Ligament is completely torn or ruptured, often accompanied by large areas of bruising.

First Aid for a Sprain or Strain

If you are unable to place weight on the area for more than two or three steps, or can't use your wrist to pick up more than a couple of ounces, it's time to see your physician and rule out the potential you have a Grade 3 rupture or a broken bone.

However, if you believe you may have a Grade 1 or Grade 2 strain or sprain, there are some simple yet effective first aid strategies you can use at home to reduce the pain and speed healing.

It is important to remember your injury may take four full weeks for complete healing and stability. It is also important you allow your body to heal the torn tissue before you go back to your preinjury activity level. An at home treatment protocol begins with RICE, an acronym that stands for rest, ice, compression and elevation. Since these terms may be misleading, let's break it down.

Rest (R) — It is important the affected area is protected and rested from stress. This does not mean you should be completely inactive, as not moving the area can decrease blood flow, strength and mobility, as well as promote more swelling. Any movement should be within the capacity of the affected injury, meaning it does not cause further injury and does not cause pain.

Ice (I) — Apply ice for 15 to 20 minutes every few hours for the first 48 hours after the injury. You can make effective ice packs at home with a 50/50 ratio of isopropyl alcohol and water, filling a resealable plastic bag half full. Wrap the ice pack in a cloth so you don't cause skin damage by placing it directly on your skin.

In the first 48 hours, ice can help reduce swelling, pain and muscle spasms. After the first 48 hours ice can become less effective, reducing flexibility and elasticity of the connective tissue in the muscles. If you have any vascular disease, such as diabetes, or decreased sensation in the area, speak with your physician before using ice.

Compression (C) — Compressing the injured joint using an elastic bandage will help immobilize and protect it from further injury and help reduce swelling. Taping, bracing or a compression garment is also good for this. Do not wrap tightly as it can hinder circulation.

When using an elastic wrap, begin in the area of the injury farthest from your heart, wrapping toward your body. Loosen the elastic wrap if pain increases, if the area becomes numb or if there is swelling below the wrapped area.

Elevate (E) — The injured area should be elevated to the same level as your heart, maximizing the power of your circulatory system to help remove damaged tissue and reduce swelling. This also helps the injured tissue establish cellular homeostasis.

In addition to RICE, if you suffer a Grade 2 or Grade 3 sprain or strain, you'll need to use crutches and immobilize the area until the tissue has healed enough for weight bearing.21 You'll also likely benefit from a home physical therapy program to restore strength and flexibility to the joint as healing progresses. In some cases, Grade 3 injuries are immobilized in a cast for several weeks. 

You have several alternative options for pain control so you won't have to resort to over-the-counter or prescription drugs, increasing your risk of experiencing side effects.

Astaxanthin — One of the most effective oil-soluble antioxidants known, astaxanthin has very potent anti-inflammatory properties. Higher doses are typically required and one may need 8 milligrams or more per day to achieve this benefit.

Arnica — This popular homeopathic remedy is used for pain management. It's available orally and topically, but there are important precautions to consider before using you'll find discussed in my previous article, "Arnica: This Powerful Herb Promotes Various Kinds of Healing."

Ginger — This herb is anti-inflammatory and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice.

Curcumin — Curcumin is the primary therapeutic compound identified in the spice turmeric. In a study of osteoarthritis patients, those who added only 200 milligrams of curcumin a day to their treatment plan had reduced pain and increased mobility.22

In fact, curcumin has been shown in over 50 clinical studies to have potent anti-inflammatory activity, as well as demonstrating the ability in four studies to reduce Tylenol-associated adverse health effects.

Boswellia — Also known as boswellin or "Indian frankincense," this herb contains powerful anti-inflammatory properties, which have been prized for thousands of years.

Bromelain — This protein-digesting enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form, but eating fresh pineapple may also be helpful. Keep in mind most of the bromelain is found within the core of the pineapple, so consider leaving a little of the pulpy core intact when you consume the fruit.

Cayenne cream — Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting the body's supply of substance P, a chemical component of nerve cells transmitting pain signals to your brain.

Prevent an Injury to Keep Moving

While you may not be able to avoid an accident, prevention is the best medicine to avoid an injury. Regular sport-specific stretching and strengthening, as part of your overall physical conditioning program, may help to minimize your risks.23 It's also important to be in shape to play your sport, rather than playing your sport to get in shape.

A physically demanding occupation may require regular conditioning to prevent injuries. The best brace you can use in your workouts or at work are your own muscles to protect your joints. Develop a balanced fitness program in order to incorporate strength training, flexibility and cardiovascular exercise.24 

Remember to warm up to prepare to exercise and drink plenty of water to prevent dehydration. Regularly schedule days off from vigorous exercise and rest when you're tired, as fatigue and pain are indications your body is more at risk for injury. Seek to avoid the weekend warrior syndrome, trying to get at least 30 minutes of moderate to strenuous activity every day.