Strains and sprains are soft tissue injuries of ligaments and muscles. Ankle sprains a common form of soft tissue injury seen in community care. Muscle strains or ‘pulls’ are very commonly in sports which involve sprinting or jumping. Injury can be due to over-stretching the muscle i.e. gym activities or causing the muscle to contract too strongly.

Cuases 
  • Strenuous Gym Activity 
  • Sporting Injury 
  • Accidents 


Referral Criteria 

A&E Referral:

  • Unexplained deformity
  • Limited limb movement
  • Swelling
  • Chills and malaise accompanying the injury

GP referral:

  • Unusual bruising or excess bruising needs to be ruled out of more serious underlying disease such as leukaemia.
  • Bruising as a result from side effects of some drugs, e.g. steroids, carbimazole.
  • Excessive bruising as a result of anticoagulants should also be referred urgently as this is likely to be caused by haemorrhage due to the worng dosing
DIfferntial diagnosis 
  • If the patient finds it difficult to bear weight and bone tenderness is present a fracture may have occurred.
  • A referral for further investigation is needed if there are signs of tendon rupture, damage to cartilage, nerve injury or tendonitis.


Patient Tips
  • Warm ups and stretching are seen be beneficial
  • Strength and endurance training
  • External ankle supports have been shown to reduce the likelihood of ankle injury.


Non-Pharmacological Treatment

RICE Method Rest, Ice, Compression and Elevation) 







Ice- Using an ice pack or submerging affected area in ice cold water for up to 10-15 mins

Compression- An elasticated bandage applied to the affected part for up to 48 hours after injury restricting swelling

Elevation- Useful to is to raise affected area above the level of the heart if possible to restrict swelling

Pharmacological

Analgesia 

Paracetamol is the first-line choice in mild sprains and strains

See page for more details

Oral NSAIDs

Ibuprofen helps to reduce the time a strain or sprain takes to heal.

Oral route usually considered first line over topical- but may not be suitable for patients with co-morbidities such as asthma, hypertension, renal impairment, and heart failure.

See page for more details

Topical NSAIDS

Topical NSAIDs have a better gastro-intestinal side effect profile compared oral route but the effectiveness is the same. But localised reactions such as skin rashes with topical preparations should be considered.

See page for more details

Arnica Gel (Herbal)

Aids with the relief of muscular aches, pains and stiffness, sprains, bruises and swelling.

Clinical evidence shows there is a effectiveness to support its use.

Homeopathatic arnica shows little effectiveness little evidence is available to support its use in this form.