Synonyms in a broader sense
Distortion, twisting
Definition
Sprain is one of the most common sports injuries. The cause of the sprain is a violent overstretching of a joint, whereby internal structures such as ligaments or the joint capsule are damaged. The large, much-used joints such as the hand, foot, knee and above all the ankle joint (supination trauma) are particularly often affected.
As a rule, the sprain is accompanied by swelling, pain and sometimes even bruising at the corresponding location. In most cases, therapy can be limited to cooling the injured joint, immobilizing it and elevating it. After a few days, the patient should be free of symptoms again.
The sprain is counted as a sports injury, as it usually develops during sports activities. Among sports injuries, it is one of the most common, and the most preferred location of the sprain is the ankle joint (i.e. the joint between the foot and the lower leg). The cause of a sprain is a violent impact on the joint from outside.
Normally, a sprain occurs when there is a sudden and unexpected movement that is not consciously performed and which exceeds the actual physiological mobility of the joint. The most typical example, which is probably known to almost everyone, is the “twisting” of the foot, in which the ankle joint is overstretched. This often happens in sports such as soccer, tennis, basketball, or those that require walking or jumping on uneven ground.
Sprains of the knee joint are also not seldom seen in soccer, since this joint is often twisted, especially when fouls are committed. Sprains of the finger and wrist joints, on the other hand, are more common in sports such as volleyball or skiing. In all these cases, the two surfaces of the joint are shifted against each other and the capsule and/or the ligaments involved in the joint are damaged.
The extent of the damage can vary greatly in the case of a sprain. Sometimes, the joint structures are only slightly to moderately overstretched, but then resume their normal position and function. However, in the case of a more severe impact, the ligaments or even the joint capsule may tear.
Frequent sprains of a joint can later be regarded as the “cause” of further sprains, since the ligaments practically wear out due to regular overstretching and are then more susceptible to further injuries. The most important symptom of the sprain is the pain, which can be very severe. This occurs mainly when the patient moves the joint.
It may even be that the pain is so severe that the joint can no longer be moved at all, in which case there is usually an additional, more severe injury such as a broken bone. In the case of a pure sprain, however, the joint should still be able to bear at least a minimal amount of stress despite limited functionality. However, the limited movement can also be caused by the fact that the site of the sprain usually swells up considerably relatively quickly.
Since joints are normally very well supplied with blood, a violent impact can also cause blood vessels to tear, resulting in a bruise (hematoma) at the affected area. The diagnosis is made either by the person affected or by the doctor, whereby the typical symptoms are usually sufficient as a basis. If the joint is swollen, painful and discolored blue (due to the bruise), but still slightly resilient, a sprain can be assumed.
Knowing exactly how the accident occurred is also useful to confirm the diagnosis. However, if there is uncertainty as to whether it is just a sprain or something worse, such as a torn ligament or a broken bone (for example, a haematoma that does not go away for a long time), the doctor can take further action to make a diagnosis. These include a detailed physical examination and imaging procedures such as an X-ray, computed tomography (CT) or magnetic resonance imaging (MRI).
Sprains often occur as a result of falls or injuries in sports.Typical injury sites include
- The wrist
- The Thumb
- Foot or ankle joint
- The toe
- The knee
Sprained wrist is a widespread phenomenon, especially among ball sportsmen and women as well as skiers and snowboarders. A sprain of the wrist occurs when the joint is overstretched. In principle, this can happen in both directions, but more often the overstretching of the wrist in the direction of the back of the hand is injurious.
Since the perceived pain and the extent of the swelling do not necessarily have to correspond to the severity of the injury, and since there is always the risk of a fracture, one should consult a doctor and at least have an X-ray taken. Both one of the two forearm bones and the small bones of the metacarpus may have been affected. If this is not the case, the sprained wrist can be splinted or bandaged.
The bandage should be tight enough to provide support, but loose enough not to interfere with blood flow or nerves. If the fingers turn white or start tingling or become numb after the bandage or bandage is applied, this is a clear indication that the bandage is too tight and needs to be reapplied. With good splinting and relief, a sprain of the wrist then usually heals completely in a period of about 10 to 14 days.
A sprain of the thumb is usually caused by an unnatural movement of the thumb outwards or strong pressure and a simultaneous sprain from above, as is easily caused by flying balls. It is therefore also one of the classic sports injuries. The so-called thumb saddle joint, which is located at the direct transition of the hand to the thumb and is responsible for a large part of the thumb’s movements, is most frequently affected.
As with all sprains, the optimal therapy consists of cooling and relieving the joint. The latter is done most skilfully with an elastic bandage or a special tape. Taping is also a good way to prevent a new sprain when playing a high-risk sport such as volleyball.
The tape stabilizes the joint, making it more resistant to renewed injuries. A sprain of the knee is more likely to be a twist in most cases. Nevertheless, doctors often use the term “distorsio” for both a sprain and a twist.
However, the term distorsio actually means torsion. Athletes who perform fast start-stop movements such as footballers or skiers are particularly at risk. In the case of a sprained knee, which is accompanied by swelling, you should always seek medical advice, as a layperson cannot distinguish whether the knee is “only” sprained or, for example, a torn meniscus, cruciate ligament, inner or outer ligament.
Since the treatment of the above-mentioned injuries differs greatly and must always be checked by means of an imaging procedure (e.g. X-ray, CT, MRI), it is advisable to seek medical attention. The treating physician can also determine a scheme according to which the knee – if it is only sprained – is to be treated and spared and decide from when a renewed sporting activity is okay. In order not to endanger and put unnecessary strain on the joint, these instructions should be followed at all costs.
The sprain of the foot or more precisely of the ankle is the most common of all sprains. The cause is usually a so-called supination trauma, i.e. bending the foot to the side. The upper ankle joint in particular is at risk of injury.
Often a sprain then occurs in combination with a rupture of the syndesmosis ligament or a fracture of one of the lower leg bones. For these reasons, one should consult a doctor after a twisting of the foot, which is accompanied by severe pain and/or swelling. With the help of an X-ray (and, if necessary, a computer tomography or magnetic resonance imaging), it can be safely ruled out that serious injuries have occurred.
Nevertheless, even an isolated sprain of the foot should be treated adequately. Depending on its severity, it can be left in place with cooling and a subsequent supporting bandage with elastic bandages or a special tape, or in more severe cases, an ankle splint or even a lower leg cast. However, a plaster cast is only necessary in very severe cases and then usually only for a few days.In contrast, a splint (a so-called ankle joint orthosis) is not so rarely used.
After healing, the ankle joint is in most cases just as stable as before. Only in individual cases does a slight feeling of uncertainty remain. However, after several consecutive sprains of the ankle or after an injury that has not healed properly, permanent instability in the joint and the joint capsule can easily occur.
The capsule of the ankle joint, which is actually intended to stabilize the movements of the foot, warps and loses tension. As a result, the affected foot is even more at risk of twisting and suffering another sprain. Unfortunately, these frequent second or third injuries can then ultimately lead to premature arthrosis of the ankle joint due to the permanent incorrect loading of the joint, which then cannot be reversed.
In individual cases, frequent twisting injuries are therefore a reason for surgery to tighten the ligaments and the capsule again, thus minimizing the risk of osteoarthritis. A sprain of a toe is a rather minor injury but not necessarily less painful than others. The sprain of a toe is not necessarily always a sports accident but can also occur in everyday life.
To reduce the pain and allow the sprain to heal well, a bandage or tape bandage is useful. Both can be wrapped so narrowly that it is still possible to wear normal shoes. When walking, the affected person will quickly find a technique that allows him or her to walk with less pain.
This is perfectly acceptable and even desirable, as it can relieve the strain on the toe. Care should be taken not to carry out this gentle gait for too long, as otherwise incorrect posture and unnatural strain on the bones and joints, which in turn can lead to problems, are imminent. A sprain of the toe usually heals in a few days without consequences.
However, if a patient still notices pain or problems after more than a week, he should consult a doctor. It is possible that the toe is broken after all or that it is some other continuing problem. The treatment of sprains depends primarily on the severity of the injury, but also on the patient’s age or individual needs.
For example, it will be more important for a young competitive athlete to regain the full load-bearing capacity of the joint than for an older person who may not be able to walk as much anyway. First aid is particularly important in the case of a sprain, which usually takes place directly at the site of the injury. Treatment here follows the so-called “PECH rule“: the “P” stands for pause.
The joint should not be subjected to any further unnecessary stress in order to avoid further damage and an increase in pain. It is best to immediately stop the previously performed activity and immobilize the affected extremity. The “E” stands for ice.
You should ensure that you cool down as soon as possible after the injury. This can be done in the form of ice bags, cold spray, cold compresses or wraps. This causes the vessels to contract, the affected area is less supplied with blood and the development of a haematoma and the resulting swelling is less likely.
Pain is also relieved by cooling. However, care should be taken to ensure that ice does not come into direct contact with the skin so that local frostbite does not develop. Treatment with heat or alcohol on the affected area should be avoided at least for the first 24 hours.
The “C” stands for compression. It is recommended to apply an elastic compression bandage in addition to cooling. The regionally dosed pressure also ensures that less blood flows through the tissue.
The bandage also helps to stabilize the damaged joint. The “H” stands for high support. The injured area should always be elevated.
This reduces the blood flow again due to gravity. In principle, the limb can be elevated on any object; if nothing suitable can be found, another person present can simply hold the limb up. However, he should be careful not to move the joint in order not to cause additional pain to the person concerned.
For further therapy, which normally does not exceed one to two weeks, practically the same rules apply as for initial treatment, which all have the purpose of protecting the joint. It should be cooled and elevated as often as possible.If a bandage is needed at all, a simple tape bandage or an elastic bandage is sufficient. Under certain circumstances, a decongestant and cooling ointment can be used, which brings relief of symptoms and sometimes even faster healing.
However, if the sprain is accompanied by permanent damage, these conservative (i.e. non-surgical) measures are not sufficient to achieve a final healing of the joint. Surgery should be performed to restore the full functionality of ligaments and/or capsule. Surgery can also be performed to prevent the joint from becoming unstable (e.g. worn ligaments), which is especially desired by people who are active in sports.
In this case, however, the protection period of the affected extremity is extended to about 4 to 6 weeks. Since sprains most often occur during sporting activities, prevention is also most important in this area. A warm-up program should always be carried out prior to sports activities, which must include a pronounced stretching and loosening of the joints that will be stressed later.
In addition, a state of training appropriate to the activity is recommended, since movements that the joint does not know to such an extent are often not tolerated. Many sprains can also be avoided with the help of appropriate equipment. For example, one can put on shoes that extend beyond the ankle and thus protect it, or bandage joints or apply a tape bandage.
This should be done especially if the joints have already been strained. The duration of a sprain is usually between one and several weeks, depending on the extent of the sprain and accompanying injuries. The acute phase, in which a lot of cooling is required, usually lasts for about 48 hours.
In this phase the injury is still very fresh. Afterwards, the affected area slowly begins to swell. Those affected can use blood circulation-promoting ointments or creams, which can help to remove the swelling and any bruising faster.
In the case of minor sprains, things now happen very quickly: the injury improves from day to day and within a week most patients can already report freedom from pain. In order not to take any risks, one should be patient with sports activities for about a week after the painlessness sets in. Afterwards, however, nothing stands in the way of this.
The situation is different for more severe sprains or even combined injuries. These usually require long-term immobilization after the first acute phase. This can be expected to last about 2 to 3 weeks.
If the sprain has occurred in combination with a torn ligament or similar, immobilization can also last up to 8 weeks. This is followed by a slow reconstruction of the muscles and initially lighter loads. After severe sprains, a break from sport of about 12 weeks is nevertheless to be expected in the best case.
After the end of these 3 months, however, sport and full exertion are usually possible again. Both the sprain and the contusion are frequent injuries. In addition, both are often sports injuries.
So what exactly is the difference between a bruise and a sprain? A bruise, lat. contusio, is usually caused by an external impact and usually affects the muscles more.
A sprain, lat. distorsio, on the other hand, is caused by twisting or overstretching of mostly joints. The mechanism of the accident is therefore essential for differentiation, less the result of the injury.
The symptoms with which both injuries manifest themselves are almost identical. Both are classically associated with pain, bruising, swelling and functional limitations. Unfortunately, probably for this very reason, both terms are often used synonymously and confused.
Therefore, it is not uncommon, for example, for a violent blow to the muscles of the upper arm (such as by a flying ball or similar) to be called a “sprain”. One should not be confused by this. Sprains are very common, especially due to external violence during sports, and are caused by overstretching certain joint structures.
The typical symptoms are swelling, pain and bruising. However, if the sprain is not accompanied by other injuries such as actual torn ligaments or broken bones, it is relatively harmless. It usually heals on its own after a few days to weeks.To speed up the healing process, the patient should make sure that he/she moves the compressed joint as little as possible, cools and elevates it regularly and gradually returns to its full range of motion without rushing anything.
