What is the difference between a sprain and a strain?

A sprain injures a ligament, the tissue that joins one bone to another and stabilizes a joint. A strain injures a muscle, a tendon or the point where they meet. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) names ankles, knees and wrists as the areas most vulnerable to sprains, while running, jumping and sudden starts and stops raise the risk of a hamstring strain.

Can a sports hernia heal without surgery?

Often it can. The American Academy of Orthopaedic Surgeons reports that in many cases, 4 to 6 weeks of physical therapy resolves the pain and allows a return to sports. If the pain returns when you resume sports, surgery to repair the torn tissue may be considered, and most athletes return to sports 6 to 12 weeks after it.

How do I know if a sports injury needs a doctor?

NIAMS lists sudden, severe pain, extreme swelling or bruising, being unable to put weight on a leg, knee, ankle or foot, being unable to move a joint normally, extreme weakness of the injured limb, and a bone or joint that looks out of place. Those injuries need a health care provider, and most fractures and dislocations need immediate care. Physical therapy comes after that evaluation.

Sports Injury Physical Therapy in Buffalo | Lake Erie Physical Therapy

Q: Should I completely rest tendonitis?

Rest matters, but it's rarely the whole plan. MedlinePlus says your provider will recommend resting the affected tendon so it can recover, and may suggest physical therapy to stretch and strengthen the muscle and tendon. In practice, that usually means scaling back whatever provokes the pain, staying active otherwise, and rebuilding the tendon's tolerance in steps.

Sprain, strain and tendonitis get used as if they mean the same thing. They don’t. A sprain is a ligament injury, a strain is a muscle or tendon injury, and tendonitis is an irritated, painful tendon, usually from asking it to do too much, too often. Each heals on its own timeline, which is why tendonitis physical therapy looks different from rehab for a rolled ankle or a pulled hamstring. At Lake Erie Physical Therapy in Buffalo, we treat all three, along with a groin injury that hockey, soccer and football players know well: the sports hernia.

Which one do you have?

Sprain: a stretch or tear of a ligament, the tough band that joins one bone to another and stabilizes a joint. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) names ankles, knees and wrists as the areas most vulnerable.
Strain: a twist, pull or tear of a muscle, a tendon, or the point where they meet. NIAMS notes that running, jumping and sudden starts and stops put hamstrings at risk.
Tendonitis: Tendons are the fibrous structures that join muscles to bones, and a swollen or inflamed tendon is called tendinitis (also spelled tendonitis). MedlinePlus lists the elbow, heel (Achilles), knee, shoulder, thumb and wrist as common sites.

Sprains and strains usually happen in a moment. Tendonitis more often builds from repeating the same motion over and over. NIAMS lists risk factors such as increasing your intensity too quickly, overtraining, playing one sport year-round and a prior injury, and MedlinePlus adds aging tendons and conditions such as rheumatoid arthritis or diabetes.

Does this need a doctor first?

Physical therapy does not replace a medical diagnosis. NIAMS advises seeing a health care provider for severe injuries, with warning signs that include:

Sudden, severe pain, or extreme swelling or bruising
Not being able to put weight on a leg, knee, ankle or foot
Not being able to move a joint normally, or extreme weakness in the injured limb
A bone or joint that looks out of place, which needs immediate care

See a physician, too, if tendon pain began during or after a course of a fluoroquinolone antibiotic; NIAMS notes this class of antibiotics is linked to tendinitis and tendon rupture. Get medical care right away for a painful groin bulge that won’t go back in, turns red, purple or dark, or comes with nausea, vomiting or fever.

Tendonitis physical therapy: adjusting the load

Your first visit is a one-on-one evaluation of how the pain started, what your sport or job demands, and how the tendon handles motion and strength testing. MedlinePlus says your provider will recommend resting the affected tendon so it can recover and may suggest physical therapy to stretch and strengthen the muscle and tendon. When overuse is the cause, a change in work habits may be needed to keep it from coming back, and for athletes, training habits count too. In practice:

Find what the tendon tolerates today. We scale back the activity that provokes it instead of shutting everything down.
Strengthen it gradually. Exercises load the tendon and the muscles around it, progressing as symptoms allow, and become your home program.
Fix what changed. More mileage, a new racquet, a heavier work week: we look for whatever came right before the pain.
Return in steps, from practice to partial play to full play.

Hands-on manual therapy and pain-relieving modalities can help early on, but neither replaces the strengthening. When a tendon can’t handle heavy loading yet, blood flow restriction training lets lighter weights do more of the work; Dr. Will Tso, PT, DPT, Cert. MDT, is Level 1 certified in BFR. Elbow tendons have their own page on tennis and golfer’s elbow.

Muscle strain treatment

NIAMS notes that many sports injuries can be treated at home with rest, ice, compression and elevation (R-I-C-E). From there, muscle strain treatment moves from protecting the muscle to gentle movement, progressive strengthening, and finally speed and sport-specific work. NIAMS also notes that a rehabilitation program with exercise is usually recommended before you return to the activity that caused the injury. Hamstring strains get a fuller look on our hip pain page.

Low back strains: the QL and the SI joint

“QL strain” and “SI joint strain” refer to two real structures. The quadratus lumborum (QL) is a deep muscle on each side of the lower back, running between the pelvis and the lowest rib. The sacroiliac (SI) joints connect the base of the spine to the pelvis, near the dimples above the buttocks. Both areas can hurt after lifting, twisting or an awkward movement. One-sided pain there also commonly comes from the lumbar spine itself, so we don’t settle on a label until the exam supports it; repeated movement testing with the McKenzie Method can show whether your back is the driver.

Sprains: more than waiting out the swelling

A sprained ankle, knee or wrist needs its motion, strength and balance back, not just time. Rehab moves from protecting the joint to restoring range of motion, then strength, then balance and agility drills that match your sport or job. Ankle sprains and Achilles tendonitis are covered in more detail on our foot and ankle pain page. A knee that buckles, locks or swells quickly after a twist should be checked by a physician for a ligament or cartilage tear.

Sports hernia (athletic pubalgia) physical therapy

A sports hernia is a soft tissue injury in the groin, and despite the name, it’s different from a traditional inguinal hernia. The American Academy of Orthopaedic Surgeons (AAOS) explains that it most often happens in sports that require sudden changes of direction or intense twisting, such as ice hockey, soccer, wrestling and football. Evan Johnston, PTA, who coaches wrestling at Frontier High School and football in Grand Island, sees those demands up close.

According to AAOS, it typically causes severe groin pain at the time of injury, pain that eases with rest but returns with sport, and no visible bulge, although over time a sports hernia can lead to an inguinal hernia. Groin pain has other possible sources, including the hip joint, so get a physician’s diagnosis first; AAOS notes that doctors use an exam and may order X-rays or an MRI.

Sports hernia physical therapy treatment can begin about two weeks after the injury, after a stretch of rest and ice, and focuses on strength and flexibility in the abdominal and inner thigh muscles. AAOS reports that in many cases, 4 to 6 weeks of physical therapy resolves the pain and allows a return to sports. If the pain comes back when you resume play, surgery may be considered, and most athletes return 6 to 12 weeks afterward; we then follow your surgeon’s protocol.

Getting back to your sport

Return to play should be earned with testing, not just time on the calendar. Our sports physical therapy page explains how we judge readiness.

With most plans, New York’s direct access law lets you start without a referral for up to 10 visits or 30 days, whichever comes first; some insurers still require a referral to pay, so check with us. Work injuries are different: Workers’ Compensation requires a referral from your treating physician, physician assistant, podiatrist or nurse practitioner. Injuries from a car accident billed to No-Fault need a referral too.

Sidelined by a sore tendon or a pulled muscle? Call (716) 332-4838 or request an evaluation, and bring your training plan or game schedule so we can work around it.

Sources

Written by the Lake Erie Physical Therapy clinical team. This page is general information, not a diagnosis; your physical therapist will assess your situation in person.

Tendonitis, Sprains and Strains