Main
- Sprain — damage to the ligamentous apparatus of a joint in which some of the ligament fibres are torn.
- The ankle, knee and wrist joints are most often affected, as they bear the main load when walking and falling.
- Main signs: pain on movement, swelling, restricted mobility, redness and local rise in temperature.
- The diagnosis is made by an orthopaedic traumatologist after examination; to rule out a fracture, X-ray, MRI or ultrasound is prescribed.
- Recovery includes rest, cold in the first hours, fixation with a bandage or orthosis, physiotherapy and therapeutic exercise.
What is a sprain
A sprain is damage to the ligamentous apparatus of a joint, in which the fibres are stretched or partially torn. This section explains what happens to the joint, what causes the injury and who is most likely to experience it.
What happens in the body
A ligament is a dense bundle of connective tissue that holds the bones of a joint close to each other and limits movement within acceptable limits. During a sudden movement that exceeds the usual range of motion in the joint, the fibres of the ligament do not have time to stretch gradually and begin to separate. Some of the fibres remain intact, while some tear, and it is the number of damaged fibres that determines how pronounced the condition is. Swelling appears in the area of damage, and pain occurs when trying to put weight on the limb or turn the joint. Movement in the joint becomes limited, and the joint itself loses its usual stability under load. The ankle, knee and wrist joints are affected most often, since they bear the main load when walking, running and falling. If the ligament is not allowed to recover, the joint remains unstable, and repeated injuries occur more easily.
What causes it to develop
- Sudden twisting of the foot: while walking or running the foot turns to the side, and the ligaments of the ankle bear the entire load.
- Falling onto an outstretched arm or leg: body weight is transferred to the joint at an awkward angle, and the ligament cannot withstand such a direction of movement.
- Unsuccessful landing after a jump: at the moment of touching the ground the joint is in an extreme position, and the muscles do not have time to hold it.
- A sudden turn or braking during sports: the body changes direction faster than the joint can adapt to the new position.
- Injury from a collision or blow: an external force displaces the joint beyond its usual amplitude, and the fibres of the ligament tear.
Who experiences it more often
Sprains are more common in people whose daily life involves running, jumping or sudden changes of direction. Athletes in team sports sustain such injuries during matches and training, when the joint works at the limit of its capabilities. People who rarely engage in physical activity are also at risk, since their muscles support the joint less well in an awkward position. In winter, falls on slippery surfaces add to this, and in summer, injuries on uneven ground and during active games. In children and adolescents the ligaments are more elastic, so their growth plates are affected more often than the ligaments themselves. In older age the ligaments lose some of their strength, and even a minor twist of the leg leads to damage. Those who regularly load their joints should strengthen the muscles around them to reduce the risk of repeated injury.
What symptoms can there be?
Symptoms of a sprained ligament depend on the degree of injury and can range from moderate pain to serious limitation of movement. Let us look at how to recognise the condition at an early stage and in which cases immediate medical help is required.
How it is noticed at the very beginning
In mild cases, a sprained ligament manifests as moderate pain on movement, which is often put down to fatigue after exertion. A person may notice discomfort in the joint area only when trying to step on the limb or turn it. Over time, swelling of the soft tissues is added to the pain, and the joint begins to respond less well. If these signs are ignored, the load on the injured ligament continues, and the damage worsens. In more serious degrees, the pain becomes severe, and swelling and limitation of mobility increase rapidly. In such cases, the person can no longer fully bear weight on the limb or make a usual movement. Therefore, at the first signs, one should reduce the load on the joint and see an orthopaedic traumatologist without waiting for the symptoms to worsen.
Signs that occur most often
- Pain in the joint area: it intensifies on movement and subsides at rest, which helps to distinguish the injury from ordinary fatigue.
- Swelling and puffiness: the soft tissues around the joint increase in volume, and this is noticeable even without a special examination.
- Limitation of mobility: the joint bends or straightens poorly, and bearing weight on the limb becomes difficult or impossible.
- Redness and local rise in temperature: the skin over the joint feels warmer to the touch than the neighbouring areas and changes colour.
- Haematoma or bruise: a dark patch sometimes appears at the site of injury, indicating more serious tissue damage.
When to seek help urgently
Examinations and tests
Examination for a sprained ligament is needed to assess the severity of the injury and rule out a fracture. The diagnosis is made by a trauma and orthopaedic surgeon after examination and assessment of movement in the joint.
How the examination begins
The examination begins with a doctor's examination and palpation of the joint area, because it is these actions that provide the first information about the state of the tissues. The trauma and orthopaedic surgeon assesses movement in the joint and compares the injured side with the healthy one to understand the extent of the restrictions. During palpation, he determines exactly where the tenderness is concentrated and whether there is swelling of the soft tissues. The doctor also checks whether the supporting function of the limb is preserved and whether there are signs of joint instability. If movement is sharply restricted or the pain persists for a long time, this becomes a reason to prescribe additional investigations. To clarify the degree of damage and rule out a fracture, the patient may be referred for radiography, MRI or ultrasound examination of the soft tissues. Write down when the pain appeared, how it changed and what you did before the appointment, so that the doctor gets the full picture.
What is prescribed and what it shows
What is worth preparing for the appointment
- History of the injury: recall and describe exactly how you sustained the injury and at what moment the pain appeared.
- Timing: state how much time has passed since the injury and how the sensations have changed during this time.
- Previous images: bring the results of radiography or other investigations if they were done earlier for this joint.
- Discharge summaries: bring the doctors' conclusions if you have already sought help for this injury or similar complaints.
- Observations: note what makes the pain worse and what brings relief, and tell the doctor about this at the appointment.
- Questions: write down in advance what you want to clarify with the doctor, so as not to forget anything important during the conversation.
Which doctor should I see?
For a sprain, help is provided by a trauma and orthopaedic surgeon, who assesses the condition of the joint and selects the treatment. Below — who to consult, what happens at the appointment and what recovery consists of.
Which specialist manages this condition
A sprain is managed by a trauma and orthopaedic surgeon, since it is this doctor who deals with injuries of the joints and the ligamentous apparatus. At the appointment, he examines the injured area, checks the range of movement and the stability of the joint, comparing it with the healthy side. The doctor clarifies the circumstances of the injury: how the person twisted their leg or arm, whether they could bear weight on the limb immediately after it happened. If a specialist is not available nearby, first aid is provided by a surgeon or a general practitioner at the polyclinic at the place of residence. Such a doctor is able to rule out a fracture and, if necessary, refer to a trauma and orthopaedic surgeon for further follow-up. With marked swelling and pain, one should not bear weight on the limb, and it is better to move with someone's support. There is no need to delay the visit: an early examination helps to determine the severity of the injury more accurately and to avoid habitual joint instability in the future.
What treatment consists of
- Rest and unloading: the injured limb is given rest and relieved of load so that the ligament heals without additional tension.
- Cold in the first hours: cooling helps to reduce pain and to contain the increase of swelling in the area of the injured joint.
- Immobilisation: an elastic bandage or orthosis holds the joint in a physiological position and limits unnecessary movements during everyday activities.
- Physiotherapy and therapeutic exercise: these methods restore mobility and gradually strengthen the muscles around the joint so that it can bear load again.
- Surgery: surgical intervention is considered for a complete rupture of the ligament or joint instability, when conservative measures do not give the required result.
What depends on the patient themselves
The result of recovery largely depends on how regularly the person follows the doctor's recommendations and is followed up by him. If the joint is spared longer than necessary, the muscles around it weaken, and returning to the usual load becomes more difficult. A premature return to sport or heavy work, on the contrary, prolongs the healing time and increases the risk of a repeat injury. Wearing an orthosis or bandage makes sense for exactly as long as the specialist has determined: uncontrolled prolongation of immobilisation limits mobility. Therapeutic exercise sessions give an effect when performed systematically, and not from occasional sessions from time to time. A simple observation helps to notice progress: the swelling decreases, weight-bearing on the limb returns, movements become freer. If the pain intensifies or the joint "gives way" again, this should be reported to the doctor, rather than waiting for the next scheduled visit.
What helps prevent an exacerbation?
Prevention of exacerbations in ligament sprains largely depends on the everyday decisions of the person themselves. Below is an analysis of which habits and observations help reduce the risk of repeat injury.
What to change in habits
Warming up before training or physical work prepares the ligaments and muscles for the load and noticeably reduces the risk of damage. Wearing comfortable shoes with good support reduces the likelihood of twisting the foot on uneven surfaces. Strengthening the muscles around the joints creates additional support and takes some of the load off the ligaments. Avoiding sudden movements on uneven surfaces is especially important for those who have already had a sprain. Using protective orthoses when the risk of injury is increased helps keep the joint in a safe position. Regular physical activity with a gradual increase in load trains the endurance of the ligaments without overloading them. A sudden return to the previous volume of movement after a break often leads to repeat injury, so the load is increased step by step.
What to keep under control
- Warm-up: a short preparation before exercise warms up the muscles and reduces the risk of a sudden ligament sprain.
- Footwear: a comfortable pair with good support holds the foot and reduces the likelihood of twisting on uneven surfaces.
- Muscle strength: strengthening the muscles around the joints creates support and takes some of the load off the ligaments during movement.
- Pace of load: a gradual increase in activity allows the ligaments to adapt without overloading and repeat damage.
- Protective orthoses: when the risk of injury is increased, they help keep the joint in a safe position during activity.
How often to see a doctor
A regular check-up with a doctor is needed even when the joint does not bother you and you feel well. The specialist assesses how the ligament is healing and notices changes that the person themselves does not feel. After a sprain, it is useful to see a doctor routinely to make sure that mobility and support have fully recovered. If instability appears when walking or swelling returns after exertion, the visit should not be postponed. The doctor will advise which movements are safe now and when you can return to your usual activity. Such monitoring helps to adjust the load in time and prevent a new exacerbation. Routine visits are a way to keep the situation under observation, not a reason for anxiety.
What is worth remembering
A sprain is a condition where it is important not to lose time and not to harm yourself with wrong actions. Below are the conclusions that help make a calm and considered decision.
Key conclusions
A sprain requires careful attention to your own sensations in the first hours after the injury. If the pain and swelling increase, and bearing weight on the limb becomes difficult, it is not worth postponing a visit to the doctor. Self-diagnosis is a poor helper here: by external signs it is impossible to distinguish ligament damage from a more serious injury. Attempts to work the limb through the pain or to continue the load often increase the damage and lengthen recovery. Cold and rest in the first day are a reasonable measure, but they do not replace an examination by a specialist. Further recovery depends on how consistently the person follows the doctor's recommendations. A sprain is a reason to rely on a professional assessment, and not on patience and the expectation that everything will pass on its own.
