Sprain or Strain: What’s the Difference?

Dennis J. Bernier, DO, MPH, FACEP is a board certified emergency medicine physician practicing at the Inova Emergency Room – Ashburn, Inova Loudoun Hospital Emergency Room, and Inova Emergency Room – Leesburg. He serves as Medical Director of the Inova Asburn ER, and Assistant Medical Director for the Inova Loudoun Hospital ER and Inova Leesburg ER.

Summer is finally here, and for many people that means getting outside for some fun in the sun. Walking, hiking, biking, golfing – regardless of your favorite activity, any of these can sometimes lead to a sprain or strain.

Sprains and strains are common injuries suffered by athletes and non-athletes alike. With the symptoms being very similar, many have a difficult time deciphering between the two conditions – so, what’s the difference?

It all depends on whether the ligament (sprain) or muscle (strain) is injured.

Ligament = sprain. Muscle = strain.

While certain joints are affected more than others, ligaments are found throughout the body. A ligament is fibrous, connective tissue that attaches bone to bone. One example of an important ligament in the knee which provides stability is the anterior cruciate ligament, or the ACL.

In the ankle, the anterior talofibular ligament is the most commonly injured ligament when a person “twists” his or her foot. This injury causes pain on the outside of the foot or ankle and can cause swelling, tenderness to the touch, and bruising. Ligaments may be over-stretched or even completely torn. The extent of the injury will determine the necessary treatment and time for the injury to heal.

A strain refers to an injury to a muscle or tendon. A tendon is the end of the muscle made of tough tissue that connects the muscle to the bone. An example of a muscle strain is a “pulled hamstring,” where the muscles on the underside of the thigh have been over-stretched and injured. This can cause pain, sometimes swelling, and even bruising.

What to Do: Start with Rest, Ice, and Elevation

It can be tough to tell whether you have a strain or sprain because many of the symptoms – such as pain, swelling, and bruising – are similar. Even broken bones can cause similar symptoms. Rest, ice, and elevation are good initial approaches.

If you cannot walk or you suspect a broken bone, you should keep weight off the injured area and see a healthcare professional. Emergency Rooms (ERs) and many urgent care centers are equipped with on-site X-ray capabilities. An urgent care center likely offers a lower cost, while an ER is more likely to offer you a radiologist interpretation of the X-ray shortly after it’s performed. An ER can also offer you a consult to an orthopedic doctor in real time if necessary and apply a proper splint to support the injured area as needed.

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