What is a ‘Sprain’?
A sprain is an injury to a ligament.
The word sprain could be used interchangeably with the word ‘tear’.
Sprain seems to fit better as a descriptor of low grade/minor ligament injuries, with tear perhaps more appropriate when describing higher grade/severe ligament injuries.
Essentially, it describes damage or injury to a ligament resulting in pain and, depending on the level of injury, joint instability.
Ligament sprains will always occur from trauma or a ‘moment in time’ when an injury occurred such as a twisting movement or an opponent falling across your leg (in the case of a knee or ankle ligament injury).
Grading of ligament sprains
While there are a number of proposed grading systems for muscle strains, there seems to be a greater consensus regarding the grading of ligament injuries with a simple 3 grade system most commonly used.
- Grade 1
- Grade 2
- Grade 3
Grade 1 – Mild
- Mild pain
- Mild tenderness to press on
- No instability
Grade 2 – Moderate
- Moderate/Significant pain
- Moderate/Significant pain to press on
- Partial tear of ligament
- May be instability present
Grade 3 – Severe
- Severe pain and swelling
- Complete tear of ligament
- Highly likely to be instability present
Management of ligament sprains
There are a number of proposed ways to manage acute ligament injuries, mostly represented by acronyms such as ICE, RICE, RICER, PRICER, POLICE and more recently, PEACE + LOVE.
The PEACE + LOVE approach is our preference due to acknowledging the subacute and chronic stages of healing better than the other aforementioned acronym based approaches, however a few of these points are probably still up for debate so please discuss this with your physiotherapist.
P = protection
E = elevation
A = avoid anti-inflammatories
C = compression
E = education
+
L = load
O = optimism
V = vascularisation
E = exercise
(Dubois & Esculier, 2020)
Your physiotherapist will be able to explain these components in more detail and discuss the best management for your individual presentation.
P = Protection
Protecting your injured ligament from further trauma/stretching is extremely important in the acute stages, particularly with grade 2 and 3 sprains.
This will allow the ligament to heal and stiffen to avoid permanent instability.
Usually this involves bracing or taping the affected ligament/joint to protect the ligament in the early phases of healing.
There are different protocols for bracing/immobilising specific ligaments based on the location and level of injury.
If you experience a ligament injury, seeing your physiotherapist as soon as possible is important to ensure optimal protection of your injury.
How long will my ligament sprain take to heal?
Every injury will be different with a myriad of factors combining to determine tissue healing.
A rough estimate would be:
- Grade 1 ligament sprain = approximately 0-2 weeks
- Grade 2 ligament sprain = approximately 4-12 weeks
- Grade 3 ligament sprain = approximately 6 weeks – 6 months
There is also a difference in timeframes between recovery to the point of returning to activity, and complete tissue healing.
Hence, even though a grade 2 ligament sprain might take 6 weeks to heal, you can usually return to lower level activity well before complete tissue healing, especially with the use of taping or a brace.
You physiotherapist will guide you through the rehabilitation progress and advise you on what level activity is safe and appropriate throughout your recovery.
You can read more here:
References
Dubois B & Esculier J-F. (2020). Br J Sports Med
2020;54:72–73.