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How to Tell a Sprain from a Strain

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Sprains and strains are basic terms for two different diagnoses but they both consist of an ‘over-stretching’ or tearing of tissues through trauma and/or overuse. Both will present with bruising and pain localised to the affected area, and they can both be categorised from minor to severe depending on the extent of damage to each tissue.

Which is which?

A sprain is the stretching or tearing of a ligament, the tissue that joins bones to each other. There are many ligaments supporting each individual joint of the body in order to stabilise the bones as they move and glide on each other.

A strain however, or ‘pulled’ muscle is when either a muscle or the tissue which connects a muscle to the bone, tendon, is overstretched or torn. This can happen during sport or exercise, but also in everyday activities or accidents. A strain can happen to every muscle group in the body, although it is seen more frequently in certain ones.

What Causes Sprains and Strains?

There are some factors, which can make your tissues more susceptible to either strain or a sprain.

Strains are more likely to affect tight or tired muscles, which have not been ‘warmed up’ properly before being over-used. The typical presentation is of an amateur athlete who attempts running a long distance without sufficient training or warm up prior to the event. Their lack of training will likely mean they have a muscle imbalance in their thighs, and insufficient nutrition for the demanding event. This is a typical picture for someone presenting to a physiotherapist with a hamstring strain.

Sprains are less likely to have a particular picture, due to them happening for a variety of reasons. One of the most commonly sprained structures are the ankle ligaments. Due to the ankles relative high mobility and being a particularly small and distal joint, it can be damaged easily. When walking whilst distracted on an uneven surface, the ankle is likely to roll outwards, more so if that person is not used to walking on that type of terrain. Heavier individuals are also more likely to tear the tissue due to the increased weight being transmitted through the fibres.


With both strains and sprains, previously damaged structures are more predisposed to further injury. Repeat injuries can be an athlete’s nightmare, with these nagging injuries affecting ability to train and eventually perform in events.

How Severe is Your Sprain or Strain?

After assessment (and possibly a x-ray, MRI or ultrasound), the damage to your joint will be classified owing to the presentation of instability and the thickness of the tear. Below is the grading system used for soft tissues:

Grade 1 (Minor)

Only a few of the fibres of the tissue are damaged (<50%). There is some tenderness around the area, but the joint remains stable and the muscle remains strong through all range of movement.

Grade 2 (Moderate)

More damage than a Grade 1 tear (>50%), although some fibres remain intact. There is increased pain and some significant swelling in the area, as well as some weakness of the muscle or instability around the joint.

Grade 3 (Severe)

There is a full tear of the tissue. The joint will have severe instability or the muscle is unable to move the joint and the patient presents with severe swelling and pain on movement of the joint.

How to Treat Sprains and Strains

A minor or moderate sprain and strain are both usually treated using a principle to limit internal bleeding and swelling, and promote healing of the joint by limiting movement. This may be referred to as the acronym ‘RICE’. RICE stands for:

Rest: allowing the affected area to rest will prevent further damage. Weight-bearing or strenuous activity on an unstable ankle joint or torn muscle around that area can further increase the damage to the area. However, the affected limb should still be moved gently to prevent stiffness in the area.
Ice: Using ice or a cold-compress intermittently for 10 minute periods provides an analgesic effect by numbing the area and reduces the amount of swelling.
Compression: Having the affected area taped to provide support, or by purchasing a specific joint support/bandage, can limit the amount of swelling in the area and provide the stability which the joint will be lacking.
Elevation: Having the area elevated will also reduce pooling of the swelling around the area and joint.

Sometimes this treatment can include anti-inflammatory medications (such as Ibuprofen) to further assist the reduction in swelling of the area.

For Severe Grade 3 strains and sprains, it is likely that surgical intervention would be required. Following the repair of the muscle or ligament, you are likely to be immobilised to allow the structure to heal. This may be from a plaster cast, a brace or a removable sling/boot.


Following an injury like this, it is advisable to see a physiotherapist. Their expertise in taping can provide temporary support for a joint or muscle. They can also provide you with exercises to increase flexibility and strength to the affected area, particularly after surgical management.

The team at Physiocomestoyou can also provide you with warm-up exercises and techniques to stretch to prevent further damage, while helping you return to the beloved hobby you’ve been resting from. Contact us today to book an appointment at work or home!

Post by Zoe Birch, Head of Orthopaedic Physiotherapy at Physiocomestoyou.