Brief overview
- Symptoms: Pain in the affected joint, movement of the joint may not be possible, swelling and bruising possible.
- Prognosis: The injury usually heals within two weeks if the joint is rested.
- Causes: rapid rotational movement of the joint beyond its natural limits, often during sports
- Risk factors: Obesity, lack of exercise, sports with frequent changes of direction, sports on uneven terrain, previous ligament damage, congenital connective tissue disease
- Treatment: Painkillers, immobilization of the joint, first aid according to PECH rule (rest, ice, compression, elevation)
- Diagnosis: Examination based on symptoms and history, differentiation between ligament strain and ligament tear by imaging techniques
- Prevention: In the case of a previous ligament injury, wear a bandage as a preventive measure, exercise regularly in moderation.
What is a ligament strain?
The application of force causes the ligaments, which are actually not very elastic, to be stretched in length. Depending on the intensity of the force and the strength of the ligament, it is stretched more or less – up to a certain degree. Once a certain stretch is exceeded, the ligament sometimes tears completely or partially (ligament tear).
A ligament stretch is the first degree of a ligament injury. Grade two is a partial tear, while grade three, ligament tear, is the most severe form.
Depending on the sport, some joints are particularly at risk: In volleyball, for example, a torn ligament in the fingers is typical; in ball sports such as soccer or tennis, the foot and ankle are particularly often affected by a ligament strain. The cruciate ligaments and the inner ligament of the knee are frequently injured during jerky twisting movements of the foot, for example when skiing or playing soccer.
If we compare the frequency of ligament strains over the entire body, we find that when ligaments are strained, the knee or foot are affected more often than the fingers. Ligament strains are least likely to occur in the elbow or shoulder. Ligament strains account for about 20 percent of all injuries in sports. However, it is difficult to determine how many ligament strains occur in everyday life because not all cases are medically examined, diagnosed and treated.
How does a ligament strain manifest itself?
The symptoms of a ligament strain vary depending on the location and extent of the injury. While sufferers usually have little discomfort with a mild stretch, a severe ligament strain or tear often causes severe pain. Pain occurs primarily during movements – for example, when walking.
Whether a ligament strain or a ligament tear is present, the doctor distinguishes with imaging examination procedures. Without such diagnostics, it is not possible to tell the difference. Often, when a ligament is stretched, it is no longer possible to put any weight on the ankle, foot or knee. If the ligament tears, you sometimes hear a “pop.”
After a ligament strain and tear, the joint is noticeably unstable. This makes further ligament strains likely. For complete healing, the affected joint is immobilized and rested for a sufficiently long time. Surgery may be necessary to prevent further ligament injury.
How long does healing take?
During this time, the joint can hardly bear any weight; sports and longer runs are out of the question. If the pain or swelling has not subsided after this time, a torn ligament is possible, with which affected persons should consult a doctor in any case.
Whether one is unable to work with a ligament strain and for how long depends on the affected joint and, of course, on the occupation performed. This also applies to activities such as driving that may be involved. In any case, it is advisable to cure joint injuries well to avoid possible late effects.
If a ligament strain is not treated, instability in the affected joint may occur as a late consequence. The malposition damages the joint cartilage, resulting in premature joint wear (arthrosis).
Causes and risk factors
Ligament strain usually occurs during sports when the joint is subjected to excessive or very sudden stress. Joints of the fingers, the knee joints and the ankle joints of the foot are particularly susceptible to ligament strain. Classically, ligament strain occurs during rapid twisting movements. A natural, healthy rotation is possible up to a certain degree.
After that, during a slow movement, the rotation is automatically stopped by the ligaments. Fine sensors are located in the ligaments and the muscles that report this state of tension to the brain. Affected persons perceive the stretching of the ligaments as a “pulling” sensation, which disappears again by changing the position of the body and the joints.
If the movement is very fast, the excessive tension cannot be corrected, so the ligament is overstretched and may even tear.
The typical mechanism of injury in the knee joint is a rotation of the knee with the foot fixed. In soccer, for example, it often happens that athletes get caught in the turf with their shoes. Therefore, in the case of a ligament strain, the ankle and knee are particularly often affected. This is also usually the case in skiing, when the ski gets stuck in the snow while the rest of the body continues to rotate.
Injuries to the ankle ligaments are also very common. For example, when jogging, hiking or doing sports on uneven terrain, a careless moment often already leads to a “twisting ankle”. Supination trauma” is particularly common, in which those affected do not step with the sole of the foot, but instead roll over the outer edge of the foot and thus twist their ankle.
Although a ligament strain usually occurs during sports, it also occurs in everyday situations. For example, if you slip down the stairs or twist your ankle, the ligaments are also subjected to excessive stress and a ligament strain is the result.
You should also have such a “minor injury” examined by a doctor in any case if there is severe swelling and lasting pain. Especially if the pain or swelling does not subside after a ligament strain, a ligament tear is also possible.
Certain factors usually increase the risk for ligament strain. Risk factors for ligament stretching include:
- Obesity
- Lack of exercise
- Fast-paced sports involving frequent changes of direction (squash, badminton, tennis, volleyball, skiing, soccer, etc.)
- Sports on uneven terrain
- Previous damage to the ligaments (ligament strain, ligament tear)
- Congenital connective tissue diseases such as Marfan syndrome or Ehlers-Danlos syndrome
The right contact person for suspected ligament sprains is a specialist in orthopedics. Try to immobilize the affected joint as much as possible on the way to the doctor. In the case of injuries to the foot, this can be achieved by using crutches, for example.
At the doctor’s appointment, the doctor will first ask you questions about your current complaints and any previous illnesses or previous operations (medical history). Describe the course of the accident and the symptoms as precisely as possible. Common questions the doctor may ask include:
- Where exactly is the pain localized?
- What exactly happened in the accident?
- Have you already had injuries to this joint?
- Have you already had surgery on the joint?
- Do you do any sports? If so, what sports and how intensively?
He will also try to move the joint carefully. If the ligament is torn, the affected joint may be in a malposition. Further examination is necessary to determine the exact extent of the ligament strain.
Further examinations:
A ligament strain or tear can be visualized with various imaging techniques. In orthopedic practice, an ultrasound machine is usually used, with which the orthopedist can easily see ligament injuries of superficially located ligaments (such as at the ankle joint). Deeper-lying ligaments, such as the cruciate ligaments in the knee, are better seen using magnetic resonance imaging (MRI).
Treatment
In the case of a ligament strain, various options for therapy can be considered. The most important thing is to take it easy on the joint and not to put any further strain on it.
First aid: “PECH” – What to do in case of ligament sprain?
Immediately after the injury, you improve the prognosis by taking certain measures (“first aid”). The necessary measures are well summarized by the so-called “PECH rule”. Here the individual letters stand for:
P for PAUSE: Stop exerting yourself immediately and sit or lie down. Even if the pain seems bearable at first. If, for example, you resume sports after a few minutes, you risk aggravating the injury.
C for COMPRESSION: If possible, you should apply a compression bandage. This also prevents bleeding into the tissue.
H for HIGHLIGHT: Keep the injured area elevated. This makes it easier for venous blood to flow back to the heart. This reduces the swelling.
Even if the pain subsides quickly, you should have the injury examined by a doctor. Distinguishing a strained ligament from a torn ligament is impossible for the layperson and only possible for the doctor with further examination.
If you continue to play sports with a ligament injury, it may lead to serious consequences: If the injury does not heal properly, sometimes the instability in the joint causes recurrent injuries. If the joint remains in a malposition, there is a risk of joint wear (arthrosis).
Strained ligaments: treatment by a doctor
Different stabilization options are available depending on the injured joint:
Ligament stretching: ankle joint
In case of a ligament strain in the ankle joint, functional bandages are applied to stabilize and relieve the joint, the so-called tapes. For this purpose, the doctor sticks elastic plasters on the skin, which are supposed to take over the function of the ligament. In addition, splints or classic bandages prevent the foot from twisting again.
Ligament stretching: knee
In the case of a ligament strain in the knee, the treating physician applies a stretching splint to immobilize the knee joint. In addition, the leg is often immobilized with bandages. There are also special splints that allow the knee some limited mobility (orthoses).
Ligament strain: Finger
In the case of a ligament strain in the finger, the affected finger is usually fixed to the adjacent finger with a stable bandage. In this way, the ligamentous apparatus is no longer stressed and heals.
Strained ligaments: How long to take sick leave?
This is followed by another examination. If the ligament strain has healed well and you have hardly any pain, it is then possible to go back to work. Professional athletes must take it easy for several weeks in any case. If you start exercising again, you should only do light exercises at first and gradually put weight on the joint.
People who are mostly sitting usually do not need to take sick leave, or only for a few days. Try to elevate your leg even when working and walk slower and more carefully than usual. There is usually no sick leave for a sprained ligament in your finger, unless you have to do manual labor or type on a computer.
Prevent
Because a previous ligament injury increases the risk of re-injury, wearing a brace as a preventive measure, such as when playing sports, is one way to prevent it. It provides additional stability.
