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Sprain - tearing of a ligament
Strain - tearing of a muscle and/or tendon


Levels of severity: determined by passive range of motion assessment for sprains,  resisted range of motion for strains very difficult to access because of inflammation assessment is best done by a physician. this information is provided so you know what is possible
Sprains: tears in ligaments
Level 1
  • 1-50% tear of ligament fibers and minimal muscle tissue damage
  • some swelling
  • no loss of function
  • joint is stable and painful

    Level 2
  • 50-99% tear of the ligament and joint capsule
  • joint hypermobile and unstable
  • decrease in tensile strength of ligament
  • swelling, bruising, bleeding
  • Level 3
  • 100% tear of ligament
  • no joint end feel present
  • usually no specific pain, but compensational pain
  • needs physician attention

    Strains: tears in muscles and tendons
    Level 1a
  • 1-10% partial tear of fibers
  • little or no loss of function
  • can hold against resistance with pain
  • Level 1b
  • 10-50% fiber tear
  • painful, but can hold against resistance
  • as it approaches 50% less ability to hold against resistance
  • swelling
  • muscle guarding
  • Level 2 
  • 50-99% fiber tear
  • can't hold against resistance
  • may hold against gravity
  • pain, edema, swelling and muscle guarding
  • Level 3
  • 100% fiber tear
  • usually heard snap at time of injury
  • no resistance possible
  • pain may be present at site
  • compensational pain present
  • Needs physicians attention immediately
  • Causes: gradual or trauma:  increased load on the muscle/ligament that is not strong enough to do hold the weight.
    over use, overextended muscles/ligaments, improper warm up before activity,

    Treatments: treat according to stage of inflammation treat according to severity of injury ice massage Triggerpoint Myofascial release begin massage treatment as soon as possible to reduce adhesion formation especially with muscular strains.

    General guidelines:
    Acute stage:  lymph drainage, ice massage, passive range of motion,
    Subacute stage: cross fiber friction, muscle energy or strain/counterstrain techniques, add strengthening as inflammation decreases,  trigger point therapy, myofascial release
    Chronic stage: cross fiber friction for ligaments, cross fiber friction of muscles,

    Cautions: Traction may aggravate if it over-stretches muscles. Stretching may over-stretch and re-injure muscles. Repeated injury to ligaments can cause the ligament to become looser and more prone to re-injury. Be sure you are trained in treating acute injuries.

     Other therapies: acupuncture, prolotherapy for ligaments, chiropractic, naturopathic (provides nutritional support needed for proper healing and functioning)


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