Sprain vs. Strain: What’s the Difference and How to Prevent Them, According to Physical Therapists

When you first injure yourself you may be too busy hobbling around in pain to wonder whether you have a sprain or strain (or something else entirely). But once the initial pain subsides, it can be hard to tell the difference between the two. Both sprains and strains are soft tissue injuries, which means they affect your muscles, ligaments, and tendons. 

“My patients often get confused as to which one they have, and why it matters,” says Heather Broach, PT, DPT, a physical therapist with Hinge Health. “I explain to them that while they may have similar symptoms as well as initial treatments, there are some differences between the two.” To make matters more confusing, you can actually have both a sprain and a strain, explains Dr. Broach.

Sprains and strains are both common injuries, and they’re also very treatable. Here’s a look at what each one is, plus how to prevent and treat them.

What Is a Sprain?

A sprain is a stretch or tear of ligaments, the band of tissue that connects two bones together in your joints. Some of the most common sprains are:

• Ankle sprain. Often the result of “rolling” your ankle, these may occur if you walk or exercise on an uneven surface, or land awkwardly when you jump. 

• Knee sprain. These can happen if you pivot abruptly during exercise. They’re especially common during activities such as basketball or agility workouts. 

• Wrist sprain. These can happen if you fall and land on your outstretched hand.

• Thumb sprain. Doctors tend to see these related racquet sports like tennis. They’re also a common ski injury.

When a sprain happens, you may actually hear a “pop” in the joint. This may indicate that a ligament has become injured during movement. But a popping sound isn’t always a bad sign. There are instances when a popping sound simply indicates that air is moving in the joint, which is usually harmless. Other symptoms of sprains include:

• Pain

• Swelling

• Bruising

• Decreased range of motion

What Is a Strain?

Also known as a pulled muscle, a strain is an injury to a muscle or tendon, the tissue that connects your muscles to your bones. One simple trick to remember the difference between a sprain (which affects ligaments) and a strain (which affects tendons and muscles) is that strain has a “t” like tendon. 

A muscle strain may cause symptoms similar to sprains, as well as spasms, weakness, and cramping in your muscles. They often occur in the lower back and your hamstrings, which are the muscles behind your thighs.

Risk Factors

Sprains and strains can happen to anyone, but here are some things that can put you more at risk:

• Deconditioning. If you haven’t been active for a while, you may be more likely to pull a muscle or experience an injury if you do more than your body is prepared for. “For instance, deconditioning affects your balance, which can make you more likely to fall and experience a sprain or strain,” points out Dr. Broach. You’re also more at risk if you’ve gone from being very sedentary to suddenly being active, which is why it’s best to increase your activity slowly and gradually if you’ve been away from it for a while. Even increasing your activity level by five minutes at a time can help you achieve your health goals and avoid injuries. 

• Contact sports. Any sport that involves close contact with someone else — such as soccer, football, hockey, boxing, or wrestling — increases the chance of a muscle strain.

• Overuse. Generally speaking, our bodies really crave variety. Repetitive movements — whether it’s sitting, running, or swinging a golf club — have the potential to result in muscle strain, especially if you don’t incorporate variety, such as stretching and strengthening exercises to that area of the body.   

• Skipping warm-up exercises. Colder, stiffer muscles are more likely to be strained during exercise, according to research from BMC Medicine. Doing warm-up exercises before your activity increases joint range of motion and decreases muscle tension so your muscles can contract more easily the warmer they become. As oxygen comes to muscle groups, it decreases their stiffness before activity and makes them more flexible. 

• Lack of flexibility. The tighter your muscles are, the more susceptible your tissues are to both strains and sprains. Static stretching such as a quad stretch, hamstring stretch, and butterfly stretch can help to lengthen muscle fibers and increase flexibility, especially when done after exercise. 

How to Treat a Sprain or a Strain 

Most of the time, you can treat your sprains and strains at home. You may be familiar with the R.I.C.E. (rest, ice, compression, elevation) approach. While there are certain elements of R.I.C.E. that are still recommended, this is actually an outdated model and experts now recommend a more updated treatment approach: P.E.A.C.E. and L.O.V.E. 

Follow P.E.A.C.E. for the first few days after a sprain or strain, which involves: 

• Protection. You don’t want to avoid movement altogether, but it’s okay to scale back and reduce activities that cause an uptick in pain or swelling.  

• Elevation. Raise the affected joint above your heart as much as possible, especially at night. It allows gravity to do its work and reduce swelling.   

• Avoid anti-inflammatories. Nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen work to stop the inflammatory process in the body, but your body needs the inflammatory response to repair soft tissue. Inhibiting inflammation can negatively affect long-term tissue healing, especially when higher dosages are used, according to the British Journal of Sports Medicine.

• Compression. An over-the-counter elastic bandage can help stop swelling — say, in your ankle or knee. Just don’t wrap it too tightly, since that can prevent blood from getting to the area.   

• Education. This involves listening to your body. Don’t feel obligated to get scans, tests, and medical interventions right away. More often than not, your body is fully able to adapt and heal on its own

After a few days, you can adhere to the L.O.V.E. protocol, which involves: 

• Load. Gradually return to normal activities, using pain as your guide for what your body can handle. Know that some pain is fine to nudge into. You want to find your movement sweet spot, where you’re challenging your body to resume normal movements without overdoing it. 

• Optimism. Engage in meaningful activities with the confidence that your body is capable of doing so. Trust that your daily activities can make your body stronger and more adaptable.

• Vascularisation. Movement promotes blood flow, which repairs the tissues that are healing. Choose activities that don’t cause an unacceptable level of pain but stimulate increased blood flow, such as biking or walking — this includes walking in place, walking at different speeds, and walking with supportive devices such as walking poles.      

• Exercise. Take an active approach to recovery that helps you regain your strength and mobility.   

“If it’s just a mild sprain, you should be able to move around and use the joint without too much difficulty after a few days,” says Dr. Broach. But if you are struggling to see progress on your own within a week, you might want to see a doctor. They may recommend physical therapy to help you regain full strength and mobility.  

“Your body will also develop compensatory strategies, which can lead to secondary pain in other joints like your hips or knees.” A physical therapist can show you exercises that will help you develop stability and strength in the affected muscles or ligaments. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

When to See a Doctor

Sprains and strains are usually not serious and can be managed with a P.E.A.C.E. and L.O.V.E. approach. Sometimes though, what seems like a strain or sprain is actually something more serious, like a fracture (broken bone). See a medical professional if: 

• Your pain is severe enough that you can’t put weight on the injured joint, or you can’t move it at all. 

• The area feels numb. 

• You took a big fall.

• There is redness or red streaks around the injury. 

• The injured area looks disfigured. 

PT Tip: Focus on Movement as Medicine

“I always tell patients that they want to get back to normal activities as soon as possible, while making modifications as needed,” says Dr. Broach. But if you’ve just had an ankle sprain, for example, you may be hesitant to walk because you have pain, and you assume that means you’re delaying healing. 

This is where a physical therapist can help. “We can work with you to show you that you won’t hurt yourself again,” Dr. Broach explains. “If you’ve had an ankle sprain, for example, we can have you walk on the treadmill with very short strides to reduce or eliminate pain. Once patients see that, their confidence grows and they can work toward resuming their regular routine and continue healing.” 

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Sprain vs. Strain: How to Recognize and Treat Each Injury. (n.d.). University of Maryland Medical System. Retrieved from https://health.umms.org/2022/06/20/sprain-vs-strain/

2. Mulcahey,M. K. (2020, June). Sprains, Strains and Other Soft-Tissue Injuries. Ortho Info – American Academy of Orthopedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/sprains-strains-and-other-soft-tissue-injuries/

3. Sprains of the Ankle, Knee and Wrist. (2022, July 28). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/15461-sprains-of-the-ankle-knee-and-wrist

4. Muscle Strains. (2022, January 28). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22336-muscle-strains

5. Guermazi, A., Roemer, F. W., Robinson, P., Tol, J. L., Regatte, R. R., & Crema, M. D. (2017). Imaging of Muscle Injuries in Sports Medicine: Sports Imaging Series. Radiology, 282(3), 646–663. doi:10.1148/radiol.2017160267

6. Recovering From an Ankle Sprain. (2021, June 21). Harvard Health. https://www.health.harvard.edu/pain/recovering-from-an-ankle-sprain 

7. Herman, K., Barton, C., Malliaras, P., & Morrissey, D. (2012). The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review. BMC Medicine, 10(1). doi:10.1186/1741-7015-10-75

8. Dubois, B. & Esculier, J. F. (2019, April 26). Soft tissue injuries simply need PEACE & LOVE. https://blogs.bmj.com/bjsm/2019/04/26/soft-tissue-injuries-simply-need-peace-love/