What is the Difference Between a Strain and a Sprain?

At a glance:

  • Strains and sprains both refer to soft tissue damage - in the case of sprains and strains this is damage to the muscles, tendons or ligaments
  • Strains refer to damage to muscles and tendons
  • Sprains refer to damage to the ligaments
  • Strains may either be acute (sudden) or chronic (developing over time)
  • Sprains are acute injuries, in almost all cases
  • Light to moderate sprains and strains may be treated at home, but severe soft tissue injuries require medical attention

What is a Strain or Sprain?

While many people may use the two terms interchangeably and share many of the same symptoms and both refer to damage done to soft tissue, sprains and strains are different and as a result require different treatment and rehabilitation.

  • Strain - a strain refers to stretched, twisted or torn muscle fibres or tendon. Strains may be acute (sudden) or chronic (develop over time) due to repetitive movement, overexertion (such as experienced when lifting heavy objects) or being in an awkward physical position for long periods of time.

Strains most often occur in weight bearing or highly flexed muscles, such as the lower back, neck, calves, shoulders or hamstrings.

  • Sprain - a sprain refers to a stretched, twisted or torn ligament. Unlike strains which can be acute or chronic, sprains are always acute, as they are typically caused by a joint being stressed by a fall, impact or rotation and the ligament being stretched or torn as a result.

Sprains can occur in any joint, but are most typically seen in the ankles, wrists, knees and digits.

Both ligaments and tendons are made up of tough, flexible, fibrous tissue, however, the similarities essentially end there. Ligaments have a dense, criss-cross structure and serve to connect bones to other bones, lending stability and structure to joints. Tendons are flexible collagen bands that connect muscles to bones, allowing muscles to transmit energy to the bones to facilitate motion. 

The size of tendons is directly related to their purpose, with load bearing tendons or those connected to large, powerful muscles typically being short and wide, and those intended for fine control, such as the tendons in the fingers being long and thin.

Soft tissue injuries such as strains and sprains are graded on a three point scale in regards to their severity:

  • Grade 1 - only a small percentage of fibres in the affected tissue are disrupted. This may result in pain and inflammation but the strength and function of the muscle or joint remains largely unchanged.
  • Grade II - a moderate amount of tearing in the affected soft tissue, leading to pain and inflammation as well as some degree of reduction in function and strength in the affected area.  This grade of injury is commonly the most painful. 
  • Grade III - significant rupturing to the affected soft tissue (either a partial or complete tear) leading to significant pain, inflammation and reduction in strength and function of the affected area.  Shortly after a Grade III injury, the pain may actually resolve.  This is because the nerve endings are also damaged in the complete rupture, and there is nothing left to feel the pain with.  This is especially common in the well known Anterior Cruciate Ligament (ACL) Rupture.  Immediate medical attention is recommended for grade III soft tissue injuries.

Symptoms of a Strain

Depending on the severity of the muscle or tendon strain, the symptoms may vary but typically include:

  • Pain at the site of the injury - the area around the strained muscle or tendon will typically be the epicentre of the pain. With a minor strain this may simply be a tenderness or twinge. With severe strains in which the muscle or tendon is torn, the pain may be excruciating.
  • Inflammation - depending on the severity of the strain, the affected area may become inflamed.
  • Muscle weakness - strains may limit a muscle or tendon’s ability to exert force or bear weight.
  • Muscle cramps/spasms - muscle fibres around the strained area may bunch and knot to protect the injured area from further damage. A cramp or muscle spasm may cause significant pain and reduction in mobility. 
  • Reduced range of motion - a strain typically results in a reduction in the function of the affected muscle. Depending on the location of the strain, this may lead to a reduction in range of motion.
  • Redness and bruising - depending on the severity of the strain and whether the muscle or tendon has been torn, redness or bruising (severe bruising in the case of a torn muscle) may occur.

Symptoms of a Sprain

Sprains are almost exclusively an acute injury so most symptoms have a sudden onset. The symptoms may vary depending on whether the affected ligament was simply overstretched or actually torn but typically include:

  • Pain in the affected joint - pain in the affected joint may be constant and sharp, throbbing or an ongoing ache. In most sprains, putting pressure on the joint (walking with a sprained ankle or knee, for example) will cause greater pain.
  • Inflammation - swelling around the affected joint.
  • Bruising - as sprains are typically caused by impact or torsion, bruising around the affected joint is common.
  • Weakness in the affected joint - people with sprains often feel weakness, or a “floppiness” in the sprained joint due to the sprained ligament being unable to properly stabilise a joint.  In some cases, such as in the above mentioned complete ACL rupture, this is the most significant symptom. 
  • Limited range of motion - in addition to weakness in a joint, people with a sprain may also experience either a reduction in range of motion of the affected joint or an inability to properly control the joint.

Get the help you need to return to full fitness and schedule an appointment to see a physiotherapist .

What causes a Strain?

Strains may be acute (sudden) or chronic (long term), so may be caused by a number of factors. Acute strains are caused by a single incident, such as lifting an object the wrong way, a sudden stop (whiplash, etc), overstretching in the case of a dancer, accelerating too quickly in the case of a running athlete, or impact. 

Chronic strains are caused either by microtraumas resulting from repetitive motions, or improper ergonomics, such as long term poor posture or staying in an awkward position for long periods of time.

Some common risk factors for strains include:

  • Racquet sports/throwing - both racquet sports and the action of throwing may strain the muscles and tendons around the elbow (tennis elbow, golfer’s elbow).
  • High impact sport or activity - sports or activities that require quick starts, turns or running and jumping increase the risk of straining a muscle or tendon in the back or legs. Such activities may be especially risky to the Achilles tendon (the tendon that connects the heel bone to the calf).
  • Poor biomechanics or ergonomics - lifting heavy objects using improper technique, having a poorly designed work area, inappropriate seating, poor posture and the like.
  • Failure to warm up before exercise - exercising or playing sports without an adequate, dynamic warmup increases your risk of straining a muscle.

What Causes a Sprain?

Sprains occur when a joint is overextended or otherwise stressed, causing an overextension or tear in the connecting ligament/s. Sprains are acute injuries and may be caused by a number of factors, including:

  • Sudden impact/fall - sprained wrists are often caused by the wrist being overextended when someone tries to brace themselves during a fall. Sprains to the digits often result from a sudden impact, such as a skiing collision or ski-pole being torn from the hand, or a hard impact to a racquet in racquet sports. Direct impact on a joint, such as a blow to the knee (accidental or deliberate) may also result in a sprain.
  • Sudden rotation - a joint being rotated unexpectedly or suddenly can severely stress the ligaments. These rotations may be caused by awkwardly landing after a jump or slip, walking, running or exercising on uneven ground, or sudden changes in direction. Sprained ankles and knee sprains commonly result from sudden rotation of the joint.

Treatment for Strains and Sprains

First and second grade sprains and strains may be taken care of at home utilising a system of treatment sometimes referred to as R.I.C.E. - R est, I ce, C ompression, E levation.

  • Rest - avoiding activities that cause or exacerbate pain in the affected area. This of course doesn’t mean that all physical activity should cease.
  • Ice - using an ice pack on the affected area may help reduce inflammation, but is now best understood to be pain relieving.  Even if you need medical attention, icing the affected muscle or joint is recommended.
  • Compression - a compressive bandage may help reduce or stop inflammation and can also lend stability to an affected joint or muscle.
  • Elevation - elevating an injured area above the level of your heart may help reduce or stop inflammation.

Over the counter pain relief medication, such as non-steroidal anti inflammatory drugs (NSAIDs) may also be used for pain relief.  Recent research, however, suggests that these should be delayed for the first 48 hours following injury.  The body’s natural healing process is the inflammatory process, and shutting this down too early with NSAIDs can be detrimental to long term healing.

Severe soft tissue injuries may require surgery to repair torn muscles, tendons or ligaments.

Tendons and ligament injury may take a long time to heal. Physiotherapy may help in this process utilising a number of techniques, including guided exercises designed to strengthen the muscles around the affected area, taping or binding of the affected area for stability and support, or the use of specialist therapies such as TENS (transcutaneous electronic nerve stimulation), ultrasound or shockwave therapy.

The discomfort and disability caused by a strain or sprain can severely impact your ability to function normally, and a full recovery may take a long time. The fastest and easiest way to book healthcare appointments online is through MyHealth1st. 


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