All too often, we see a diagnosis of a “sprain/strain” relative to the lumbar or cervical spine. There is a huge difference between the two, and the treatment may overlay initially, however, in the long run, the interventions can become quite different as will the length of duration. Thus, it is imperative that the exact diagnosis be objectified and the injury be limited to what actually occurred.
The major difference is the anatomic structures involved. Understanding that both are soft tissues, a sprain involves a ligament, a tough fibrous structure connecting bone to bone. A strain involves a tendon or muscle. Think of the anterior cruciate ligament which attaches the distal femur to the proximal tibia. When that ligament is torn (or ruptured), most often this requires surgical intervention. Although some can go through life with an unstable knee secondary to an incompetent ACL, this is not the prevailing standard of practice.
A strain of the hamstring (think pulled muscle) can be easily treated with conservative measures, such as gentle range of motion and stretching in a physical therapy clinic. A home-based program can be efficacious as well. After swelling and flexibility have returned, a strengthening protocol can be pursued. Surgery for these types of lesions is not recommended with the exception of a complete tear with retraction of the muscle.
Sprains are most often caused by a sudden extreme twisting motion that forces the bones of a joint to be out of normal position. Strains are a function of overuse and excessive wear.
The clinical presentations are often the same, (pain and swelling) however, the expected findings on clinical physical examination are markedly different. Note the history of the injury and pay particular attention to the mechanism of injury. Sprains can cause bleeding or ecchymosis. Strains can cause some swelling and a limited range of motion as the body attempts to protect itself. With the sprain of a ligament, the restrictions are removed and there is excessive motion.
As both can present as acute, it is imperative to note the exact structure that is compromised so the most appropriate treatment and intervention can be addressed as quickly as possible. To be clear, given the multiple ligaments that surround the vertebral bodies, one does not get a sprain/strain of the vertebra at any level and this diagnosis is a misnomer that results in excessive treatment and prolonged absence from a full-duty return to work. One would suggest never accepting a sprain/strain diagnosis, as doing so will add problems to this file.
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