Strains and sprains: a helpful guideline

Thousands of Canadians sprain an ankle every day, and knowing what to do can make all the difference. Home care is the first step, but you may also need to see a doctor.

• Few injuries are as sudden and painful as a strain or sprain. A strain occurs when you twist or stretch a muscle (often referred to as a "pulled" muscle) or a tendon (the band that connects muscle to bone) beyond its limit.
• Usually the muscle stays intact, although with severe injuries it can actually tear, split in two or shear away from its tendon (sometimes the ripping makes an actual "popping" sound).

• A strain typically occurs after you lift something heavy the wrong way or over-stress your muscles sprinting for a bus, swinging a golf club or even running to catch a Frisbee thrown by your six-year-old. Strains affect the muscles in your back, hamstrings (at the back of your thighs), calves, groin or shoulders. They can also affect a previously injured muscle that had not been rehabilitated properly.
• While a mild strain may not hurt too much at first, a sprain usually causes intense pain right away. It happens when a joint is forced beyond its normal range of motion. Specifically, one or more ligaments—the strong bands of connective tissue that attach bones at the joint and support them—get overstretched and/or torn.
• Sprains are generally caused by a sudden force, usually a falling or twisting motion, or a sharp blow to the body that yanks a joint out of its normal position. Your ankles are particularly vulnerable, although your knees and wrists can also be trouble spots.

• Rest, ice, compress and elevate (RICE) the injured area.
• Take acetaminophen for pain, NSAIDs (including COX-2 inhibitors) if there’s swelling.
• For moderate to severe pain, an X-ray will rule out a bone fracture or other more serious problems.

• Support yourself correctly: If you're using a cane or crutch for support when you have an ankle or knee injury, hold it on the uninjured side. This prompts you to lean away from—and lessen stress on—the injured side.
• Follow the up/down laws: Just like saints and sinners, the good go up and the bad go down. So, for the best stability when negotiating stairs, start with the uninjured "good" foot when ascending, and the injured "bad" one when descending.
• Pack in the protein: If you push yourself physically during a rehabilitation regimen, eat more protein to help repair muscles and ligaments. Choose healthful sources of protein such as poultry (without the skin), fatty fish such as salmon and mackerel (which contain potentially restorative omega-3 fatty acids), and soy foods (soybeans, tofu, soy milk).
• Fall-proof your life: It’s worth the effort to prevent future sprains. Clear clutter from walkways, stairways, the yard and driveway, as well as the path to your bathroom (so you won't trip at night). In winter, salt icy walkways. Take your time getting out of taxis and crossing streets to avoid stumbling and tripping.
• Stick to the 10 percent rule: To prevent future muscle strains, regulate your activity levels by following this golden rule: don't increase your workout—whether it’s adding mileage to a run or increasing the number of reps in the weight room—by more than 10 percent a week.

• To find out more about treating strains or sprains, or to find an orthopedic surgeon in your area, contact the Canadian Orthopaedic Association (514-874-9003 or www.coa-aco.org).