Sprains and strains: how they are treated and when it is more than a sprain

What is the difference between a sprain and a strain?

A sprain is an injury to a ligament, one of the tough bands that connect the bones at a joint. The NHS says sprains most often happen in the wrists, ankles, thumbs and knees. A strain is an overstretched or torn muscle, which people also call a pulled muscle. The NHS says strains most often affect the feet, legs and back.

The NHS lists pain, tenderness or weakness, swelling or bruising, difficulty putting weight on the area, and sometimes muscle spasms. A broken bone can cause similar signs, which is why the warning signs later in this guide matter.

What does the NHS describe for the first few days?

For the first 2 to 3 days the NHS describes five steps known as PRICE. The letters stand for protection, rest, ice, compression and elevation. Rest means stopping exercise or activities and trying not to put weight on the injury.

For ice, NHS trust leaflets describe an ice pack, or a bag of frozen vegetables wrapped in a towel, held on for 15 to 20 minutes at a time every 2 to 3 hours. Several leaflets warn against putting ice directly on the skin. Compression means a bandage that is firm but not too tight, and elevation means keeping the injury raised. The timings vary between sources.

Several NHS trusts also use the word HARM for the first 48 to 72 hours: avoid heat, alcohol, running and massage.

What does the NHS say about pain relief and moving the injury?

The NHS suggests paracetamol to ease pain and ibuprofen gel to help with swelling. It also says a pharmacist can advise on the best option. The Northern Ireland government site nidirect says ibuprofen should not be taken for the first 48 hours after an injury because it may slow healing, so advice differs between UK sources.

NHS guidance also says to keep the joint or muscle moving once pain allows, so that it does not become stiff. Some trust leaflets describe starting gentle movement early for sprains, while strained muscles are usually rested for at least a few days.

When does the NHS say to call 999 or go to A&E?

The NHS says to call 999 or go to A&E if there was a crack at the time of the injury. The same applies if the injured body part has changed shape, or if it is numb or tingling. Skin that has turned blue or grey, or feels cold, is also on the list. The NHS says not to drive there; someone else can drive, or 999 can be called for an ambulance.

When does the NHS say to get help from NHS 111 or a GP?

The NHS lists reasons to get help from NHS 111. These are pain that is very bad or getting worse, and swelling or bruising that is large or growing. Others are being unable to put weight on the injury, an area that is very stiff or hard to move, and self-care that has not helped. A very high temperature, or feeling hot, cold or shivery, can point to infection and leads to the same advice.

NHS 111 Wales says to see a GP if the injury is getting worse or is not feeling better after treating it yourself.

How long does recovery take, and when can normal activity restart?

The NHS says most sprains and strains feel better after about 2 weeks. It adds that strenuous exercise, such as running, may need to be avoided for up to 8 weeks because of the risk of further damage. NHS 111 Wales says severe sprains and strains can take longer than 2 weeks. These timings are general, and recovery that is slower than usual is one reason the NHS gives for seeking advice.

Is physiotherapy needed?

NHS 111 Wales says a GP may refer a person to a physiotherapist if recovery is slower than usual. The main NHS page adds that NHS physiotherapy is not available everywhere and waiting times can be long. A physiotherapist can assess the injury and guide exercises to restore movement and strength.