Sprains are injuries to ligaments. Ligaments are the supporting structures that join, bone to bone. Ligaments are tissues that don’t have a lot of blood supply that reach them, meaning they don’t heal as fast as other tissues, this also causes them to not be as elastic as other tissues, which causes them to not go back to their original size once they have been stretched.
These injuries occur when a joint moves beyond its normal range of motion, causing the ligament to stretch. This can happen from a direct impact, during a car accident or even during some contact sports. Sprains also occur when we move in ways we shouldn’t, such as when you twist your ankle, from walking on an uneven surface, or if you fall and land on the side of the foot rather than on the sole of the foot.
These types of injuries are categorized much like they are in strains, having 3 different severities. In most cases when there is a sprain present, it will not be the only injury present. It usually also has strains, fractures/breaks, and even dislocations if the injury is severe enough.
The first degree is mild, where there is a stretch and possible small tear in the ligament, where the person can continue their regular activities with that joint with only some discomfort. The strength of the joint is still maintained.
The second degree is moderate, where there is tearing in the ligament. This tearing can be moderate, some ligament fibers torn, or severe, most of the ligament fibers are torn. When this happens there is usually a popping sound when the injury happens, and the joint is unable to keep its stability. When the joint is moved in a passive, relaxed, motion, there is still some stability in the joint. After injury, the person will have great difficulty in continuing their activities due to pain.
The third degree is severe, where the ligament is completely torn, or where the ligament attaches to the bone is lifted off of the bone, keeping the ligament fully intact, also known as an avulsion fracture. There will not be any stability of the joint, and there is severe pain, causing the person to not be able to continue their activities at all. Even after this ligament is healed, there is usually instability of the joint, making the joint hypermobile (the joint can move beyond the regular range of motion for that joint), usually in the same direction as the injury occurred.
During the first stage of healing, from a sprain, you can have a massage. Depending on the severity of the sprain, the treatment may vary slightly, such as if you have a brace or air cast around the joint to support it, but for the most part they are the same. The area that has the sprain is raised using pillows and ice is applied. Circulatory work and lymphatic drainage is only done above the injury to make sure that the lymphatic system doesn’t become blocked, potentially causing other complications, and to decrease the swelling at the injury site. Lastly, compensating areas are treated to reduce tight muscles, knots, maintain their range of motion and relax the nervous system. During this stage of healing, it is recommended to incorporate diaphragmatic breathing to help minimize discomfort felt from the injury as well as during the treatment.
During the second stage of healing, most of the treatment stays the same. The only differences are, now trigger points that refer to the affected joint can be treated; muscle spasms that occur over the affected joint are started to be treated, using less invasive techniques; on-site work is started, but must stay within the person’s pain tolerance; relaxed passive range of motion can be done in the joints above and below the affected joint, and very gentle and slow techniques can be used below the injury.
During the third stage of healing, most of the treatment from the second stage remains the same with a few changes. Hot and cold can be used on the injury site, unless the swelling flares up, which if it does it is back to using cold compresses. More invasive techniques can be used on trigger points in muscles that cross the injured joint. The ligament itself is worked on, using frictions, to help the scarring in the ligament to become functional, so it doesn’t restrict movement later on in the healing process. Joint play, such as tractioning is done on the joints above and below the injured joint if the joint has become stiffened due to compensation. Lastly, the range of motion to the affected joint is increased, only within the person’s pain tolerance, with moving the joint into the same direction as the injury, being done last.
Then during the last stage of healing, most restrictions during treatment are no longer needed, and all swelling should be gone. If there is still some swelling present, lymphatic drainage will still be done, but the main focus is getting back full range of motion and reducing any restrictions in the joint. Strength training will start to help with supporting the joint, and keeping the person from injuring the joint again in the future. Depending on the severity of the sprain, the surrounding muscles will have to help with protecting the joint. If it is a mild sprain they won’t have to protect the joint too much, whereas if it is a severe sprain, the surrounding muscles will have to take on the responsibility of supporting the joint all on their own. Treatment will also revolve around making sure that proper posture returns, especially when a sprain happens in the lower limbs as they can change several other structures in the body, causing pain later in life, if they haven’t already during the healing process of the sprain itself.
The length of time for healing a sprained ligament will depend on the severity of the sprain, but it can take up to 6 months to heal. This time frame only works if there aren’t any post micro injuries and the person’s health during the time of the injury. Also if the person requires surgery to fix the ligaments, this healing time could cause you to need more time to fully heal the ligament.