There is a certain bugger-ation factor involved in any injury, no matter how it is sustained. The impact on day to day life, compensation elsewhere in the body, and rebuilding confidence as the injury heals. And then there’s the waiting …
It can sometimes seem to go on and on and on. We all know what injuries are like - indeed, Zoe recently wrote about coping with having sprained her ankle again.
One of the things that can really help with developing patience around an injury is to understand what has happened and typically how long it will take to repair and recover. When it comes to soft tissue ‘stuff’ there are two words which sound so similar to clients, but they have very different meanings - Sprain vs Strain. Not only is there a big difference in what type of tissue is damaged, but there is a difference in the average recovery time for these injuries.
What is a Sprain?
“A sprain is a stretching or tearing of ligaments — the tough bands of fibrous tissue that connect two bones together in your joints. The most common location for a sprain is in your ankle.” (Mayo Clinic Website).
A sprain refers to tearing of a ligament, which hold our joints together, for example the ligaments on the outside of the ankle. Nearly everyone I know has sprained an ankle at some point or another. After the initial injury, it can leave one with the odd sensation of discomfort or pain when trying to use the joint, but when resting it seems fine. Ligaments have a poor blood supply and take a long period of time to heal for this reason.
What is a Strain?
"A strain is a stretching or tearing of muscle or tendon. A tendon is a fibrous cord of tissue that connects muscles to bones. Strains often occur in the lower back and in the hamstring muscle in the back of your thigh” (Mayo Clinic Website).
The interesting thing about a muscle strain is that it can happen several ways: direct trauma, indirect trauma (overload, overstretch or a sheering force) and over-use. These tears or ruptures are mostly partial in nature, and seen as ‘first degree’ when up to 5% of the muscle fibres are affected or ‘second degree’ where more fibres are involved. ‘Third degree’ muscle strains involve a complete rupture of the whole muscle.
When a strain occurs, "the tissue fibres become torn or damaged and [this] causes bleeding and swelling” (Cash pg 77, 1996). There will likely be mild to moderate discomfort and pain, along with the visual evidence of an injury.
A strain may also refer to a tear of a tendon that connect our muscles to bones, for example the patellar tendon of the knee. “The collagen fibres making up the tendon can be torn through overuse in the same way as the muscle fibres can” (Cash pg 63, 2015). It is possible to completely rupture a tendon, typically the Achilles at the ankle or one of the two bicep tendons at the shoulder, but you will really know about this. There will be a very sharp snap with a sound (clients often talk about hearing a gunshot-like sound) but there will be very little sensation or pain afterwards. Just because there is no pain doesn’t mean there is no injury!
Remembering the difference
Being dyslexic, I found that using techniques to remember troublesome facts helps me recall them time and time again. I’m a particular fan of mnemonic devices:
Mnemonic devices are techniques a person can use to help them improve their ability to remember something. In other words, it's a memory technique to help your brain better encode and recall important information.
A favourite mnemonic I still use is when I need to write the word necessary: Never Eat Cake, Eat Salmon Sandwiches And Remain Young. Likewise, when I can see a pattern between a word and its meaning, I’m a very happy girl.
The problem with the term sprain and strain is that they refer to the same type of injury - fibres are torn or damaged because of an excessive force of some kind. However, the words themselves provide the distinction between the type of injury: strains relate to muscles and tendons, whilst sprains relate to ligaments. It’s that simple!
How long will recovery take?
There are generally agreed to be three stages of soft tissue repair:
Stage 1 Acute 'inflammatory' phase 2 - 5 days post-injury
Stage 2 Regeneration 'repair' phase 5 days - 2-3 weeks post-injury
Stage 3 Remodelling 'rebuilding' phase 21 - 60 days post-injury
(Lederman, pg 16, 2005)
Although this suggests a very definitive statement with a linear healing process, there are other factors that affect recovery - most notably the severity and location of the injury. The more fibres which were torn, the longer each stage will last, so in reality the acute stage may be as short as 48 hours or as long as a week, with remodeling lasting from between 3 to 6 weeks, but complete strength may take up to 12 months to recover if the injury was severe.
Having said all of that, there is a rough guideline of how long it will take to get back to ‘normal’ function after a soft tissue injury. Approximately 2 - 4 weeks for a minor injury, 6 - 8 weeks for a more severe injury, and a rehab programme of 12 – 16 weeks for a major injury, possibly longer following surgery for a total rupture. However, please be aware that these are rough guidelines and that each injury will be different.
How to aid recovery from a sprain and strain
Whether you tear muscle, tendon or ligament, you are likely to experience a certain amount of pain, swelling and bruising. The general advice for both a sprain and strain in the ‘acute’ stage (typically the first 2 – 3 days) is as follows:
R = rest the affected area
I = ice may slow the blood flow to the area and reduce the amount of bleeding immediately following the trauma. It is also great at reducing pain, which can therefore inhibit protective muscle spasms
C = compression may also reduce blood flow to the area and prevent further bleeding
E = elevation allows gravity to minimise excess fluid pooling in the injured area
New guidance recommends now using the mnemonic ‘PRICE’, adding ‘Protection from further injury’.
It is also now recognised that passive mobilisation and movement is vital early on in an injury to help speed recovery and tissue repair (Lederman, 2005). A therapist trained in sports and remedial massage can help with this repair process.
Other things to consider
Unfortunately, when it comes to tendon strains, “after the age of about 35, degenerative changes reduce the elasticity of tendons” (Cash pg 91, 1996). This may increase the time it will take for such an injury to recover.
Another factor to consider is the type of fibres in muscles, tendons and ligaments. Of the three types of tissue, muscle has the greatest blood supply, whilst ligaments (which you can sprain) and tendons (which you can strain) have very limited blood supply. Blood vessels are important in providing the injury site with the oxygen and nutrients required to repair the damaged tissues and removing damaged or dying cell, whilst lymphatic vessels will help provide drainage. The more blood flow to the injury site, the more swift the repair and recovery is likely to be.
“Rest is still very important in the early recovery stage, and remedial exercises must be done gently and carefully … Without sufficient rest, it does not matter how much treatment and remedial exercise is done - the condition may not recovery properly” (Cash pg 238, 2015).
Injuries suck. There’s no other way to describe the enforced rest, the pain and discomfort, the wait. However, it is really important to give yourself the best chance of recovery by understanding what you have done, and that it may well take you longer than you think to get back to ‘normal’.
Cash M. (2015) Advanced Remedial Massage and Soft Tissue Therapy
Cash M. (1996) Sport & Remedial Massage Therapy
Lederman E. (2005) The Science and Practice of Manual Therapy 2nd edi.