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Sprains and Strains

Also indexed as: Joint Injuries, Ligament Injuries, Muscle Injuries

Illustration

Beat the aches and pains of sprains and strains. According to research or other evidence, the following self-care steps may be helpful:

What you need to know

  • Control swelling and pain
  • Use the R.I.C.E treatment: Rest the body part, Ice it every hour, Compress it with elastic bandages, tape, or a brace, and Elevate it above your heart
  • Control inflammation with enzyme preparations
  • Take 4 to 8 tablets a day of proteolytic enzymes containing trypsin, chymotrypsin, and/or bromelain for inflammation
  • Take a multivitamin
  • Extra vitamins and minerals during recovery can help insure against deficiencies that slow the healing process
  • Get help for serious injuries
  • See a healthcare provider if you cannot move or put weight on the body part, if the part looks crooked, if pain or tenderness is severe, if there is numbness or redness in the area, or if you have any other concerns about your injury.

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full sprains and strains article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About sprains and strains

Sprains and strains are types of minor injuries to the soft tissues and connective tissues of the musculoskeletal system. Sprains usually refer to injuries to ligaments, but sometimes to other connective tissues, such as tendons and the capsules surrounding joints. Strains usually refer to injuries to muscles or to the areas where muscles become tendons. 

Sprains and strains may occur together, and occasionally are quite severe, requiring immobilization of the body part in a rigid cast for weeks, long-term rehabilitation programs, and sometimes surgery.

Product ratings for sprains and strains

Science Ratings Nutritional Supplements Herbs
3Stars

Enzymes (chymotrypsin, trypsin)

 
2Stars

Bromelain

L-carnitine (for preventing exercise-related muscle injury)

Vitamin A (for deficiency only)

Vitamin C

Zinc (if deficient)

Comfrey (topical)

Horse chestnut (topical)

1Star

Chondroitin sulfate

Copper

DMSO (topical)

Enzymes (papain)

Glucosamine sulfate

Manganese

Multiple vitamin-mineral

Silicon

Vitamin E (for exercise-related muscle strain)

Arnica (topical)

See also:  Homeopathic Remedies for Sprains and Strains
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

The most common type of sprain is the ankle sprain. Ankle sprains have differing degrees of severity. Mild or minimal sprains with no tear of the ligament usually produce mild tenderness and some swelling. Moderate sprains, in which the ligament has been partially ruptured, produce obvious swelling, bruising, significant tenderness, and difficulty walking. Severe sprains, as when the ligament is completely torn from the bone (called avulsion), make walking impossible and produce marked swelling, internal bleeding and joint instability.

Symptoms of strains include muscle soreness, muscle spasm, pain, and possibly swelling or warmth over the involved muscle.

Medical options

Over the counter pain medications, such as aspirin (Bayer®, Ecotrin®, Bufferin®), acetaminophen (Tylenol®), and ibuprofen (Motrin®, Advil®), are routinely recommended to relieve minor pain and reduce inflammation. Topical methyl salicylate-menthol (Icy Hot®, Ben-Gay®), trolamine salicylate (Aspercreme®), and combination counterirritant products (Maximum Strength Flexall 454®) may also help to relieve pain from muscle strain.

Prescription medications, such as acetaminophen with codeine (Tylenol® with Codeine) or acetaminophen with hydrocodone (Vicodin®), may be used for moderate pain. Strains may be treated with muscle relaxants, such as cyclobenzaprine (Flexeril®), carisoprodol (Soma®), and baclofen (Lioresal®).

Treatment of minor sprains and strains includes resting the affected area, applying cold packs or ice, wrapping the area with a compression bandage (ACE®), and keeping the affected area elevated as much as possible. Mild to moderate ankle sprains usually require strapping with elastic bandages or tape or immobilization with a brace. Health care providers recommend “RICE” for sprains and strains, which stands for rest, ice, compression, and elevation. A sprained ankle should always be X-rayed to rule out a fracture.

Dietary changes that may be helpful

Adequate amounts of calories and protein are required for the body to repair damaged connective tissue. While major injuries requiring hospitalization raise protein and calorie requirements significantly, minor sprains and strains do not require changes from a typical, healthful diet.1

Vitamins that may be helpful

Proteolytic enzymes, including bromelain, papain, trypsin, and chymotrypsin, may be helpful in healing minor injuries such as sprains and strains because they have anti-inflammatory activity and appear to promote tissue healing.2 3 4

Several preliminary trials have reported reduced pain and swelling, and/or faster healing in people with a variety of conditions using either bromelain,5 papain from papaya, 6 7 or a combination of trypsin and chymotrypsin.8 Double-blind trials have reported faster recovery from athletic injuries, including sprains and strains, and earlier return to activity using eight tablets daily of trypsin/chymotrypsin,9 10 11 12 four to eight tablets daily of papain,13 eight tablets of bromelain (single-blind only),14 or a combination of these enzymes.15 However, one double-blind trial using eight tablets per day of trypsin/chymotrypsin to treat sprained ankles found no significant effect on swelling, bruising, or overall function.16

Bromelain is measured in MCUs (milk clotting units) or GDUs (gelatin dissolving units). One GDU equals 1.5 MCU. Strong products contain at least 2,000 MCU (1,333 GDU) per gram (1,000 mg). A supplement containing 500 mg labeled “2,000 MCU per gram” would have 1,000 MCU of activity, because 500 mg is half a gram. Some doctors recommend 3,000 MCU taken three times per day for several days, followed by 2,000 MCU three times per day. Some of the research, however, uses smaller amounts, such as 2,000 MCU taken in divided amounts in the course of a day (500 MCU taken four times per day). Other enzyme preparations, such as trypsin/chymotrypsin, have different measuring units. Recommended use is typically two tablets four times per day on an empty stomach, but as with bromelain, the strength of trypsin/chymotrypsin tablets can vary significantly from product to product.

One controlled trial showed that people who supplement with 3 grams per day L-carnitine for three weeks before engaging in an exercise regimen are less likely to experience muscle soreness.17

Antioxidant supplements, including vitamin C and vitamin E, may help prevent exercise-related muscle injuries by neutralizing free radicals produced during strenuous activities.18 Controlled research, some of it double-blind, has shown that 400–3,000 mg per day of vitamin C may reduce pain and speed up muscle strength recovery after intense exercise.19 20 Reductions in blood indicators of muscle damage and free radical activity have also been reported for supplementation with 400–1,200 IU per day of vitamin E in most studies,21 22 23 but no measurable benefits in exercise recovery have been reported.24 A combination of 90 mg per day of coenzyme Q10 and a very small amount of vitamin E did not produce any protective effects in one double-blind trial.25

Vitamin C is needed to make collagen, the “glue” that strengthens connective tissue. Injury, at least when severe, appears to increase vitamin C requirements,26 and vitamin C deficiency causes delayed healing from injury.27 Preliminary human studies have suggested that vitamin C supplementation in non-deficient people can speed healing of various types of trauma, including musculoskeletal injuries,28 29 but double-blind research has not confirmed these effects for athletic injuries, which included sprains and strains.30

Zinc is a component of many enzymes, including some that are needed to repair wounds. Even a mild deficiency of zinc can interfere with optimal recovery from everyday tissue damage as well as from more serious trauma.31 Trace minerals, such as manganese, copper, and silicon are also known to be important in the biochemistry of tissue healing.32 33 34 35 However, there have been no controlled studies of people with sprains or strains to explore the effect of deficiency of these minerals, or of oral supplementation, on the rate of healing.

Many vitamins and minerals have essential roles in tissue repair, and deficiencies of one or more of these nutrients have been demonstrated in animal studies to impair the healing process.36 This could argue for the use of multiple vitamin-mineral supplements by people with minor injuries who might have deficiencies due to poor diets or other problems, but controlled human research is lacking to support this.

Glucosamine sulfate and chondroitin sulfate may both play a role in wound healing by providing the raw material needed by the body to manufacture molecules called glycosaminoglycans found in skin, tendons, ligaments, and joints.37 Test tube and animal studies have found that these substances, and others like them, can promote improved tissue healing.38 39 40 41 Injectable forms of chondroitin sulfate have been used in Europe for various types of sports-related injuries to tendons and joints,42 43 44 45 and one preliminary trial reported reduced pain and good healing in young athletes with chondromalacia patella (cartilage softening in the knee) who were given 750–1,500 mg per day of oral glucosamine sulfate.46 However, specific human trials of glucosamine and chondroitin sulfate for healing sprains and strains are lacking.

The use of DMSO, a colorless, oily liquid primarily used as an industrial solvent, for therapeutic applications is controversial. However, some evidence indicates that dilutions, when applied directly to the skin, have anti-inflammatory properties and inhibit the transmission of pain messages by nerves, and in this way might ease the pain of minor injuries such as sprains and strains.47 48 49 However no controlled research exists to confirm these effects in sprains and strains. DMSO comes in different strengths and different degrees of purity. In addition, certain precautions must be taken when applying DMSO. For those reasons, DMSO should be used only with the supervision of a doctor.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Horse chestnut contains a compound called aescin that acts as an anti-inflammatory and reduces edema (swelling with fluid) following trauma, particularly sports injuries, surgery, and head injury.50 A topical gel containing 2% of the compound aescin found in horse chestnut is widely used in Germany to treat minor sports injuries, including sprains and strains.51 The gel is typically applied to affected area every two hours until swelling begins to subside.

Arnica is considered by some practitioners to be among the most effective wound-healing herbs available.52 As a homeopathic remedy, arnica is often recommended as both an internal and topical mean to treat minor injuries. Some healthcare practitioners recommend mixing 1 tablespoon of arnica tincture in 500 ml water, then soaking thin cloth or gauze in the liquid and applying it to the injured area for at least 15 minutes four to five times per day.

Comfrey is also widely used in traditional medicine as a topical application to help heal wounds.53 In a study of people with acute ankle sprains, topical application of an ointment four times a day containing a comfrey extract was at least as effective as, and possibly more effective than, a topically applied anti-inflammatory drug (diclofenac). The comfrey ointment was a proprietary product that contained 35% comfrey extract.54

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

Holistic approaches that may be helpful

Spinal manipulation is used by chiropractors, licensed naturopathic doctors, and some osteopathic doctors to relieve pain and improve healing of sprains and strains. One preliminary trial tested a combination of chiropractic manipulation, muscle stretching, and special exercises known as “proprioceptive neurofacilitation” to people who had sprain/strain neck injuries that had not resolved with other treatment.55 Treatment was reported to help the majority of people, and over one-third reported that their symptoms were completely gone or only mildly bothersome. In a larger preliminary trial,56 people who were still suffering neck pain a year after whiplash-type accidents were treated with spinal manipulation for an average of four months. At the end of the treatments, 72% reported at least some benefit and nearly half reported significant benefit or complete recovery, but people with the most severe symptoms derived little benefit.

References:

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6. Trickett P. Proteolytic enzymes in treatment of athletic injuries. Appl Ther 1964;6:647–52.

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14. Blonstein JL. Oral enzyme tablets in the treatment of boxing injuries. Practitioner 1967;198:547.

15. Baumüller M. Therapy of ankle joint distortions with hydrolytic enzymes—results from a double blind clinical trial. In Hermans GPH, Mosterd WL, eds. Sports, Medicine and Health. Amsterdam: Excerpta Medica, 1990, 1137.

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17. Giamberardino MA, Dragani L, Valente R, et al. Effects of prolonged L-carnitine administration on delayed muscle pain and CK release after eccentric effort. Int J Sports Med 1996;17:320–4.

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25. Kaikkonen J, Kosonen L, Nyyssonen K, et al. Effect of combined coenzyme Q10 and d-alpha-tocopheryl acetate supplementation on exercise-induced lipid peroxidation and muscular damage: a placebo-controlled double-blind study in marathon runners. Free Radic Res 1998;29:85–92.

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38. Denuziere A, Ferrier D, Damour O, et al. Chitosan-chondroitin sulfate and chitosan-hyaluronate polyelectrolyte complexes: biological properties. Biomaterials 1998;19:1275–85.

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40. Glade MJ. Polysulfated glycosaminoglycan accelerates net synthesis of collagen and glycosaminoglycans by arthritic equine cartilage tissues and chondrocytes. Am J Vet Res 1990;51:779–85.

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56. Khan S, Cook J, Gargan M, Bannister G. A symptomatic classification of whiplash injury and the implications for treatment. J Orthop Med 1999;21:22–5.

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