Is It a Sprain or a Strain? How to Tell the Difference

It’s a common scenario: You’re playing basketball or simply raking leaves when you take a wrong step and twist your ankle, resulting in sudden, sharp pain. Was it a strain? A sprain? A pulled muscle? A torn ligament? What do these all mean, and how are they different?

“It’s easy to understand why people get confused, especially since sprains and strains are both common injuries that involve overstretching or tearing of tissues in the body,” says Stephanie Schmidt, MD, a Yale Medicine primary care sports medicine physician, who specializes in the nonsurgical management of musculoskeletal issues. “These injuries often occur during physical activities, and their symptoms can be the same. They just happen to different tissues.”

Below, Dr. Schmidt talks more about sprains and strains, including how they most commonly occur and how to avoid them.

Although the symptoms of sprains and strains are similar, they impact different areas.

A sprain is a stretching or, in more serious cases, a tearing of ligaments, the bands of tissue that connect bones to other bones and stabilize joints. It typically occurs in ankles, knees, and wrists. A common type of sprain is a so-called “rolled” ankle, which occurs when the ankle turns a certain way—often inward—when someone missteps or trips. The anterior cruciate ligament (ACL) in the knee, which connects the femur to the tibia, is another area that can be sprained or torn, often from quick movements in sports.

A strain can also range from minor overstretching to a more serious tear, but it affects muscles or tendons, the bands of tissue that connect bones to muscles. Common areas where muscle strains occur include the hamstring, back, and calf; areas where tendons get strained include the quadriceps and rotator cuff, both of which can be caused by overuse from repetitive movements or from an acute, or sudden, injury. For example, someone might strain their rotator cuff when they catch themselves during a fall.

“Although the terminology may be confusing when you are talking about strains, sprains, microtears, and tears, it may be easier to think of it as a continuum. Any kind of strain or sprain is, at minimum, a stretching injury of the ligament for sprains—or the tendon or muscle tissue for strains. This is considered a microtrauma,” Dr. Schmidt says. “The next part of the continuum would be small or partial tears within the muscle, tendon, ligament, or connective tissue occurring with that stretch—signaling more serious strains and sprains.”

The last part of the continuum, she explains, would be a rupture or complete tearing that goes all the way through the tissue (usually a tendon or ligament). For example, when someone ruptures a quadriceps tendon, it may detach from the knee.

The symptoms of sprains and strains are similar. They include pain or discomfort in or around a muscle, tendon, or ligament. There can also be swelling, bruising, and weakness in the injured area, in addition to a limited range of motion or an inability to put weight on the area.

Both sprains and strains tend to be sudden injuries caused by a minor trauma, such as a fall, bumping into something, overstretching, or twisting a joint. For example, you might strain your back lifting a couch or sprain your wrist if you trip and catch yourself with your hand.

Injury occurs because you are stretching the ligaments, tendons, or muscles beyond their normal range or applying a force on them that is more than they can bear.

Sprains and strains can also happen from overuse, though the onset of pain might appear suddenly. “For example, someone training for a marathon might feel a strain in their calf while out on a run,” says Dr. Schmidt. “However, the injury wasn’t the result of something traumatic, but rather the cumulative demand put on the body from intense training over time.”

Often, sprains and strains are diagnosed by a medical professional during a physical exam, during which the provider would gather your medical history and assess symptoms, such as bruising, swelling, and tenderness. Your medical provider may also perform tests to gauge certain functions, including your range of motion, strength, and stability. For example, this could include comparing how much you can rotate your shoulder on the injured side versus the uninjured side.

You may also have an X-ray to rule out broken bones. Sometimes, providers use an ultrasound machine, which can show if ligaments are partially or fully torn. If an ultrasound is unavailable or more detailed imaging is required for diagnosis, an MRI (magnetic resonance imaging) scan might be needed.

“If an evaluation indicates that an injury is most likely a minor strain or sprain that will respond to rehabilitation, rest, and activity modifications, an MRI isn’t always necessary,” Dr. Schmidt explains. “But if we think a tendon might be torn and may therefore require surgery, then we will want an MRI to make sure.”

If you are in significant pain, seek immediate medical care. But if the injury—or pain—is mild, medical professionals often recommend trying to treat it at home first with the RICE (Rest, Ice, Compression, Elevation) method—with modifications.

“The thinking on the RICE protocol has evolved with new research showing that certain elements, such as icing to reduce swelling, can possibly inhibit or slow healing,” Dr. Schmidt explains. “Previously, it was thought that swelling was a bad thing, but it’s actually your body’s natural inflammatory response and facilitates healing in the injured area.”

However, Dr. Schmidt says, if needed for pain control, it’s OK to use ice for the first 24 to 48 hours after the injury, and then stop. After that, using heat could be helpful for warming up the area before any physical activity.

Additionally, rest, in most instances, should not be interpreted as doing nothing, but instead engaging in light activity, such as putting some weight on a sprained ankle, if it’s not incredibly painful, she adds. She also recommends early range-of-motion exercises in the form of gentle movements for muscle strains. “You don’t want to push the range of motion too far, but just get some movement,” she says.

Compression (such as using a brace, bandage, or tape) and elevation (keeping an injured elbow on a pillow above the heart, for example) are still good steps in the acute stage after injury, Dr. Schmidt says. Braces can also help protect joints if there is instability. For example, with ankle sprains, a lace-up ankle brace can provide support.

Recovery time from a sprain or strain depends on many factors, including the severity of the injury and the location in the body. Mild sprains or strains, particularly in young athletes, often heal within days to a couple of weeks, Dr. Schmidt says.

“If it’s a more significant injury, meaning a partial tear, you don’t have to remain totally inactive, but you should use your symptoms to guide you as you ramp back up into your normal activities. It might take weeks to months,” she adds.

It's important to let sprains and strains heal fully, Dr. Schmidt says, because the areas where they’ve occurred can be prone to re-injury. “We want to get people moving, but we also want to make sure that we're using pain and other symptoms as our guide as they return to activities,” she says. “It’s often helpful to work with a physical therapist as you do this.”

While sprains and strains can’t always be avoided, there are steps you can take to reduce your risk. For example, if you are an athlete, it’s wise to perform mobility and flexibility exercises, which are designed to increase the range of motion in a joint. For example, the yoga pose downward-facing dog is helpful in maintaining calf flexibility and in stretching the hamstring.

Strength training, in the form of lifting weights, using resistance bands, or body weight, is also beneficial, Dr. Schmidt adds.

“Sometimes, people have tightness or weaknesses in certain areas—for instance, one side of the body is stronger than the other. That can set you up for injury on the weaker side,” she says.

Additionally, Dr. Schmidt recommends working on balance. This could include practicing yoga—even chair yoga (i.e., performing yoga poses in a chair)—or standing on one leg.

"For older individuals, there is good evidence for using tai chi to improve balance," Dr. Schmidt says. "For athletes who have had ankle sprains, progressive balance exercises are important for regaining ankle stability and a sense of body position and movement to reduce the risk of re-injury.”

Another way to avoid sprains and strains is to not increase your physical activity too quickly, Dr. Schmidt says. “For example, a person who has never run before should not sign up for a half-marathon with only a month to prepare,” she says. “That puts them at a much higher risk for getting injured versus somebody who has been running for years, has slowly ramped up their mileage, and is now ready to run their first half-marathon.”