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Fitness Medicine

Is it a Sprain or a Strain?

LigamentSprains and strains often occur together in or near a joint, since joints absorb the stress of movement and are vulnerable to be being twisted or wrenched. The ankle and the knee are the most common sites of such injuries.

 A sprain (from the French espraindre – to wring) is an injury which occurs to ligaments caused by being stretched beyond their normal capacity and possibly torn. Muscular tears caused in the same manner are referred to as a strain. In cases where either ligament or muscle tissue is torn, immobilization and surgical repair may be necessary
Although some signs and symptoms can be used to assess the severity of a sprain, the most definitive method is with the use of Magnetic Resonance Imaging (MRI). Sprains are graded in five degrees.

The first degree is only a minor tear or stretch of a ligament.
The second degree is a tear of a ligament, which is usually followed by pain or swelling
The third degree is a complete rupture.
The fourth degree breaks the ligament, along with some small bones if severe enough, and requires surgery to repair.
The fifth degree tears all the ligaments and actually breaks all the surrounding bones; sometimes cannot be repaired and results in amputation.

A strain is an injury to a muscle or tendon in which the muscle fibers tear as a result of overstretching. Strains are also colloquially known as pulled muscles. The equivalent injury to a ligament is a sprain. Strained muscles usually happen at the point where tendon meets muscle, although you can get them at any point on the muscle. When you get a muscle strain, it might be severe, but it could also just be mild or moderate.  A mild or moderate muscle tear is usually just stretched and painful.  A severe one, on the other hand, can actually cause your muscle to detach from the tendon and roll up. In mild cases, the force of the injury tears a few fibers of the ligament or muscle, causing mild to moderate pain and swelling, which usually subside within a few days. A more violent injury may completely tear a ligament or muscle and involve bone damage such as a dislocation or fracture. With proper care, most sprains and strains heal completely without complication.

The ankles are among the most vulnerable elements of the body. These complex hinges of bone, ligament, tendon and muscle support the entire body weight and may transmit a force of impact equal to three times your weight. Thus, ankle injuries, usually the tearing or straining of a ligament, are the most common of all joint injuries.

The great majority of sprains are inversion sprains. This happens when the sole of the foot turns inward, injuring the ligaments on the outside of the ankle. Eversion injuries occur when the foot turns outward, affecting ligaments on the inner side. Some sprains are minor and can be successfully treated at home, but many need medical attention. Any ankle sprain can put you at risk for another, since when the injury heals, it leaves the tendon weakened and less flexible – and thus more susceptible to injury.


Causes and Risk Factors of Sprains and Strains
Sprains and strains occur as a result of an injury, when the joint is subjected to more physical force that it can withstand. Athletes, dancers, and those who perform manual labor commonly suffer such injuries. Previous sprains may so weaken the ligaments that recurrence is possible with only minor pressure. The risk of sprains and strains increases with obesity and poor muscular conditioning.

Symptoms of Sprains and Strains
Symptoms include mild-to-severe pain in the affected joint that worsens with movement or application of pressure; swelling, redness, or bruising around the affected joint; and, in severe cases, loss of mobility in the affected joint.

Typical symptoms of a strain include: localized pain, stiffness, inflammation, and bruising around the strained muscle, loss of function, loss of normal limb function or elasticity of ligament decrease

Treatment of Sprains and Strains
First aid measures for a sprain or strain can best be remembered by the acronym RICE – Rest, Ice, Compression, and Elevation.

  • Rest the injured area. Try not to move or put pressure on the affected joint. A sling or splint may be recommended to immobilize the joint and allow damaged ligaments or muscles to heal.
  • Ice the affected area to reduce swelling. After 24 hours, either ice or heat may be applied to reduce pain.
  • Compress the joint by wrapping it in an Ace bandage to help reduce swelling and pain.
  • Elevate the joint to reduce swelling.

Take over-the-counter pain relievers to treat minor pain. Your doctor may prescribe stronger analgesics for more severe pain. After the pain has subsided, gently exercise the joint to regain strength and mobility. A physician or physical therapist may help to devise an exercise program to aid in rehabilitation. Surgery may be required in severe cases to repair torn ligaments or muscles.

Prevention of Sprains and Strains
Perform warm-up exercises before undertaking any strenuous activity. Wear a brace or elastic support, or tape or wrap joints before engaging in vigorous physical activity. Engage in regular, moderate exercise to keep muscles and joints strong and flexible.


Hyponatremia: Can You Drink Too Much Water?

Hyponatremia, also called water intoxication, is generally the result of drinking excessive amounts of plain water which causes a low concentration of sodium in the blood. Once a rare occurrence at sporting events, it is becoming more prevalent as participation increases and more novice exercisers are entering endurance events.  Prolonged and excessive sweating increases the risk that an athlete will alter the delicate balance of blood-sodium concentration. Because sodium is lost in sweat it is important for those exercising at high intensities for long periods of time to replace any loses.


Research has found that long duration endurance events, such as the Ironman distance triathlons, often have finishers with low blood sodium concentrations. Those at most risk are those who are on the course the longest, because they tend to drink the most water during the event. Runners who drink extra fluids in the days before the race or those who stop at water stop during the race are also at increased risk of hyponatremia. In fact, a study published in the New England Journal of Medicine (April, 2005) found that 13 percent of Boston Marathon runners developed hyponatremia from drinking too much water.

Causes of Hyponatremia
During high intensity exercise, sodium is lost along with sweat. An athlete who only replaces the lost fluid with water will have a decreased blood-sodium concentration. As an example, consider a full glass of salt-water. If you dump out half of the contents of the glass (as is lost in sweat), and replace that with water only, the sodium concentration of in the glass is far less and the water is more dilute. This can occur in the bloodstream of an athlete who only hydrates with water during excessive sweating. The result is hyponatremia.

Adequate sodium balance is necessary for transmitting nerve impulses and proper muscle function, and even a slight depletion of this concentration can cause problems. Studies have shown that high intensity athletes can lose up to 2 grams of salt per liter of sweat. Replacing this during the event is critical to performance and safety.

Symptoms of Hyponatremia
The early warning signs are often subtle and may be similar to dehydration and include nausea, muscle cramps, disorientation, slurred speech, and confusion. At this point, many athletes drink more water because they think they are dehydrated. Unfortunately, water alone will increase the problem of hyponatremia. At the most extreme an athlete may experience seizures, coma, or death.

Treatment of Hyponatremia
At the first sign of symptoms an athlete should drink a sodium containing sports drink or eat salty foods. Ideally, an athlete should plan ahead and estimate his or her fluid loss and need for sodium replacement during the event, and stay on a hydration schedule during the race. If the symptoms are extreme, a medical professional should be seen.

Preventing Hyponatremia
The best way for an athlete to avoid such problems is to plan ahead by training in the same conditions you will encounter during race day. Hydration recommendations include:

  • Use a sodium containing sports drinks during long distance, high intensity events (more than 60-90 minutes long).
  • Increase salt intake per day several days prior to competition (except for those with hypertension).
  • Try not to drink more then you sweat.
  • During a marathon a good rule of thumb is to drink about 1 cup of fluid every 20 minutes.
  • In the days before the race, add salt to your foods (provided that you don’t have high blood pressure and your doctor has not restricted your salt intake).
  • Avoid use of nonsteroidal anti-inflammatory (NSAIDS) medicines that contain sodium. Research suggests that these drugs may predispose runners to hyponatremia.
  • Know your body, individuals respond differently to exercise; fluid and sodium needs will vary accordingly. Foods that provide additional sodium include chicken noodle soup, a dill pickle, cheese, pretzels, and tomato juice.
  • Never have a water drinking contest. Most cases of water intoxication happened because people tried drinking 2-3 gallons in five or six minutes.

As always, it is important to consult your physician for special considerations if you have a history of any health problems or are taking any medication for a health condition.

 The kidneys of a normal healthy person can process a liter of water an hour easily. As long as you don’t binge or do anything stupid, you should be able to avoid water intoxication.