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Injuries – sprains, strains and bruises

A sprain is the forcible wrenching or twisting of a joint with partial or complete rupture of its ligaments but without dislocation. There may also be damage to associated blood vessels, muscles, tendons or nerves. Traditionally a sprain is considered to be more serious than a strain which is over-stretching of a muscle with damage to its fibrils. However in modern terminology both may be classified within the same grading system:

  • Grade 1: Mild or minimal sprain with no ligamentous tearing. Mild tenderness and some swelling may be present.
  • Grade 2: Moderate sprain consisting of incomplete or partial ligamentous rupture with obvious swelling, bruising and difficulty in walking.
  • Grade 3: Complete rupture of a ligament with swelling, hemorrhage, ankle instability and inability to walk.

Most sports and overuse sprains occur at the ankle and the following refers specifically to ankle sprains.

Ankle strains
Ankle strains are common and usually harmless although they may take weeks or months to settle. The ankle is swollen and tender. It may require a prolonged period of rest as well as other conservative measures but will usually settle. Anti-inflammatory gels could also help to relieve from the pain and inflammation.

It is important to be aware of injuries to the medial and lateral ligaments which may cause ankle instability. This typically leads to pronation and may cause other problems including osteoarthritis in later life. Once the ankle has settled, a biomechanical assessment is essential.

Groin strains
Common in football players, it causes pain in the groin. The hip is fully mobile but there is exquisite tenderness over the adductor insertion just below and towards the medial end of the inguinal ligament. If it doesn’t settle with rest, consider injecting the adductor insertion with a steroid preparation.

Sacroiliac strain
Common with lifting injuries, it causes pain and tenderness over the sacro-iliac joint which may radiate down the back of the thigh. It settles rapidly with rest. Remember – most sacroiliac pain arises from the lumbar spine and is referred. MRI scan if in doubt. Sacroiliitis is uncommon except in young men presenting with anklyosing spondylitis when it responds well to anti-inflammatory drugs. Exercise is good for it.

Bruises
Bruises, also known as contusions, develop usually after a bump or fall when small blood vessels rupture or tear under the skin. This causes blood to leak into the tissues under the skin resulting in a blue/black colour. Bruises usually heal within 2 to 4 weeks, although bruises on the leg usually take longer to heal than bruises on the face or arms.

Most bruises will go away on their own. Gentle massage may help to relieve the pain and encourage blood flow. However, severe bruising, pain and swelling that begins within 30 minutes of an injury may indicate a more serious problem, such as a fracture or severe sprain, and may require evaluation by a doctor.

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