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What to do if You Think You Have a Sprain or Strain
Dr. Robert O’Connell explains the difference between a sprain and a strain, what to do if you think you have either of these injuries and how to treat both.
Featuring:
Robert O’Connell, M.D.
Whether it’s returning to golf or running, school sports, or playing with the grandkids, every patient with a bone, muscle, or joint conditions has a personal goal in mind. And helping patients achieve those goals is what motivates Dr. Robert O’Connell. “I have always enjoyed being able to help get people back to doing the things that drive them,” says Dr. O’Connell. “It’s extremely gratifying and an honor to be able to help someone improve their quality of life.” Dr. O’Connell is an orthopaedic surgeon at VCU Health and assistant professor in the VCU School of Medicine’s Department of Orthopaedic Surgery, specializing in Sports Medicine. The surgeons and residents there practice out of five sites across greater Richmond (including the Level I trauma center at VCU Medical Center), caring for a wide range of injuries that are often related to athletic participation, with patients at all levels of competition. In terms of procedures, Dr. O’Connell specializes in minimally invasive arthroscopic and open surgery of the shoulder, hip, and knee, with a focus on joint preservation. He handles surgeries for rotator cuff tears, cartilage injuries, knee ligament/meniscal tears, and hip tears. He also performs shoulder replacements, fracture fixations, elbow arthroscopy and many other routine procedures, such as hip, knee, and shoulder injections. For most of his procedures, patients can go home on the same day of the surgery. To be a successful orthopaedic surgeon, however, requires more than time in the clinic, dedication to patients, and a commitment to lifelong learning in a fast-evolving field. “You have to really be involved in the community,” he says. “That’s why you see sports medicine physicians serving in important roles for many local schools and teams, because our work with them can have a significant impact on a lot of our student-athletes’ futures. I enjoy getting to take care of athletes so they can excel.” (He’s a golfer and runner himself). It also helps, he notes, to have a good orthopaedic surgeon you can call on for advice, or in the event you’re injured. Dr. O’Connell joined VCU Health after completing his residency here. He brings a background in biomedical engineering to his knowledge of complex arthroscopic procedures, which often require implantations to repair bones or replace missing joints. “It helps me understand the implants and devices that we use, and hopefully will position me in a place to help develop new techniques in the future,” he says. Transcription:
Evo Terra (Host): Many look forward to getting outside and participating in their favorite activities. Unfortunately, increased activity can also mean increased injury. Whether you're a weekend warrior or a student athlete, don't let a sprain or a strain slow you down. Injuries from bike riding, swimming, sports such as volleyball and baseball and running can all put a damper on a safe and injury free summer. However, with the proper treatment and care, you can get back to doing what you love as soon as possible.
Welcome to Healthy with VCU Health, where experts from VCU Health share their knowledge, cutting-edge research and the latest innovations to help you achieve optimal health and wellness. Take control of your health. I'm your host Evo Terra. Joining me today is Dr. Robert O'Connell an Orthopaedic Surgeon at VCU Health and Assistant Professor in the VCU School of Medicine's Department of Orthopaedic Surgery, specializing in Sports Medicine. Thanks for being here, Dr. O'Connell.
Robert O’Connell, M.D. (Guest): Thanks for having me Evo. I'm excited to be here and talk to you all and answer some questions for you.
Host: Let's get to the most basic thing. Tell us about your specialty. What is it that an orthopaedist does?
Dr. O'Connell: Yeah. So orthopedic doctors specialize in kind of anything to do with the musculoskeletal system. So, that would be like your bones, joints, or ligaments. There's a lot of different specialties or subspecialties within orthopaedics. I specialize in sports medicine, which has a focus on treating you kind of after you have a sports related injury or a pain that prevents you from doing activities that you like to do.
It's not always a professional athlete. It can just be a normal person that likes to walk or run or go to the gym. And orthopaedic specialists are really the doctors that are best equipped to get you back on your feet if you experience something like a sprain or strain or a fracture or any other musculoskeletal injury, that's preventing you from doing activities.
Host: Now I'm old hat when it comes to all of those things, but for the fortunate out there who aren't quite as accident prone as I, can you explain the difference between a sprain, a strain and a fracture?
Dr. O'Connell: Yeah, certainly. So, a sprain and strain are sometimes similar, but a sprain is when a ligament, which are kind of bands of tissue that connects to bones usually around the joints, kind of gets stretched beyond their limits, or even can get torn completely. And there can be varying degrees of sprains though. These can range from just a minor injury, with some pain that doesn't have significant damage to a ligament to what we call a grade three injury, where you have a complete tear of the ligament and you kind of lose the loss of function. Now, a strain on the other hand is when you do damage to muscles or tendons, which is, the same mechanism like your joint gets stretched too far or you fall down and twist something.
The tendons and the muscles can get stretched and injured and symptoms from that, you know, you can, from both of those, a sprain and the strain, you can have pain, swelling, sometimes muscle spasms, decreased range of motion of your joint and difficulty with putting weight on your joints. A fracture is really different.
A fracture is definitely a higher energy mechanism or an injury. And a fracture is when the bone is actually broken or cracked and the symptoms are usually more severe. Usually you have more kind of sudden, severe pain with lots of swelling, difficulty putting weight or moving that part of your body.
And sometimes there's even a visible deformity. So, like a visible injury that you can see that the bone is shifted from where it's supposed to be. And rarely, the bone can actually stick through the skin, which would be called a compound fracture, which is pretty severe.
Host: Yeah, that does not sound like a fun thing to have that. Luckily I have not experienced a compound fracture, but as mentioned, I do sprain and strain myself on a, well, I won't say a regular basis, but more often than I certainly would like to. So, and I know I shouldn't just run to the ER, every single time I have an injury. So, if I suspect I might have a mild sprain or strain, what should I do?
Dr. O'Connell: Yeah. I mean, if you suspect a mild sprain or strain, usually I recommend what I tell patients is RICE therapy and I'm sure a lot of people have heard that acronym. But basically stands for rest, ice, compression and elevate. Typically I also tell patients to take an over the counter anti-inflammatory medication, something like a Tylenol or Advil, which can really help with pain and swelling.
And usually after a couple of days of relative rest and activity modification, once the pain is improved, you can kind of get back to doing your normal activities. Sometimes you need to keep the area immobilized or not move it for a certain period of time. But I would tell you to be cautious about immobilization for extended periods of time, because that can cause unnecessary stiffness and scar tissue formation. So that's kind of when we would want you to see a doctor, if you're getting to that point.
Host: Sure. Yeah, that, that makes a lot of sense. Let's talk a little bit more about knowing when we should see a doctor, because I don't have an x-ray machine in my eyeballs. And so at some point in time, there might be a reason for me to go to a doctor. And for me, it probably should be going for doctor, but general advice to the audience. How does one know when a doctor is the next step?
Dr. O'Connell: So, I think initially it would be if the symptoms are really severe from the get-go. So that would be significant swelling, an obvious injury or deformity, like a fracture, an open area or open skin wound. And then other significant symptoms, which would be things like instability or feeling like you can't put pressure on your leg because it's going to give way. A lot of people will come in and say, it feels like their knee is going to give way. Are all certainly things that you should go see a doctor for. And then even if it was something like a mild injury to begin with, but it just doesn't improve after a couple of days of resting it, icing it and using anti-inflammatory modalities than that, that's again, when you should make a trip to your local doc.
Host: So the next time I slip and fall and on the way down, I see the bottom of my foot, not the part of my foot I'm supposed to see. And that's happened before. I know I need to go see a doctor. Where should I go? Where should I go and see a provider?
Dr. O'Connell: Orthopaedics at VCU Health. We have a lot of different locations. We have eight locations actually and all, have the ability to see same day kind of urgent walk-in patients. So, we have seven locations throughout the Richmond and Colonial Heights area, and then a new clinic, which has opened in Williamsburg near William and Mary there.
And all of these locations will have imaging capabilities on site. Some of them even have what we call advanced imaging capabilities, which would be like an MRI machine or a CAT Scan machine. And some of them even have physical therapy, which can really be helpful. And it's kind of pivotal, how we treat patients after injuries and the musculoskeletal system to be able to get you back to your pre-injury level. So, it's really nice having all of those in one location. And when you come see us, we'll explain the treatment options, whether that'd be short or long term, including non-operative and operative strategies if needed.
Host: So, let's walk through the mechanics. Here I am, hobbling in to see the doctor because I think I might have broken something. What should one expect from that initial visit?
Dr. O'Connell: Yeah. So typically if an injury is severe enough where you're, you've made it to an orthopaedic surgeon to get an evaluation; we're typically going to get an x-ray as kind of the first part of the evaluation. And that's to make sure that you don't have a fracture or to evaluate the fracture. And then we'll kind of use that information combined with talking to you and sitting down and examining the injured area, to come up with a treatment plan. Sometimes that's simple things like medications that we prescribe, sometimes it's things like physical therapy. You know, and in the worst case scenario, if it's something that requires surgery, then we'll sit down and discuss what the optimal timing for the surgery is.
Obviously, we want to do it as quickly as possible to get you back on your feet. But sometimes we have to wait until swelling decreases and inflammation goes down before surgery is appropriate to prevent complications after surgery. Sometimes you get something that we call like a splint or a cast which will immobilize the joint or the injury if there's a fracture that we see on x-ray or if it needs more rest to let it heal. And these are things that we can do in the office when you come see us that day as well.
Host: It's been a couple of years since I've been forced to wear the boot of shame from breaking my ankle on more than one occasion. So, refresh my memory. How long does it take before I start to recover?
Dr. O'Connell: So, recovery will be pretty dependent on the type of injury that you have. A minor sprain or strain can typically heal in about two to four weeks after a period of rest with a gradual return to activities. When you have more severe injuries, like a fracture, the bone will typically heal in about six to eight weeks.
So, like if you were in a boot, then typically that the period of boot wearing is about six weeks, but sometimes it takes longer than that to get back to your pre-injury level of activities. And then, on the other end of the spectrum, like, if you have a severe injury that requires surgery, then those can take as long as six months to even a year to recover from.
And, hopefully when we have that initial evaluation and talk about your injury is we can give you a good estimate of when we think that you're going to be back to normal and feeling better.
Host: Great information, Dr. O'Connell. Hopefully others out there aren't quite as accident prone as I am. But if in fact they are, we now have some good solutions going forward. Thank you for your time today.
Dr. O'Connell: Perfect. Thank you, Evo.
Host: Once again, that was Dr. Robert O'Connell an Orthopaedic Surgeon at VCU Health and Assistant Professor in the VCU School of Medicine's Department of Orthopaedic Surgery, specializing in Sports Medicine. Thank you for listening to Healthy with VCU Health.
I have been your host Evo Terra. To learn more about orthopaedic injuries and our same-day clinics, visit vcuhealth.org, and to listen to other podcast episodes from VCU Health, visit vcuhealth.org/podcast.
Evo Terra (Host): Many look forward to getting outside and participating in their favorite activities. Unfortunately, increased activity can also mean increased injury. Whether you're a weekend warrior or a student athlete, don't let a sprain or a strain slow you down. Injuries from bike riding, swimming, sports such as volleyball and baseball and running can all put a damper on a safe and injury free summer. However, with the proper treatment and care, you can get back to doing what you love as soon as possible.
Welcome to Healthy with VCU Health, where experts from VCU Health share their knowledge, cutting-edge research and the latest innovations to help you achieve optimal health and wellness. Take control of your health. I'm your host Evo Terra. Joining me today is Dr. Robert O'Connell an Orthopaedic Surgeon at VCU Health and Assistant Professor in the VCU School of Medicine's Department of Orthopaedic Surgery, specializing in Sports Medicine. Thanks for being here, Dr. O'Connell.
Robert O’Connell, M.D. (Guest): Thanks for having me Evo. I'm excited to be here and talk to you all and answer some questions for you.
Host: Let's get to the most basic thing. Tell us about your specialty. What is it that an orthopaedist does?
Dr. O'Connell: Yeah. So orthopedic doctors specialize in kind of anything to do with the musculoskeletal system. So, that would be like your bones, joints, or ligaments. There's a lot of different specialties or subspecialties within orthopaedics. I specialize in sports medicine, which has a focus on treating you kind of after you have a sports related injury or a pain that prevents you from doing activities that you like to do.
It's not always a professional athlete. It can just be a normal person that likes to walk or run or go to the gym. And orthopaedic specialists are really the doctors that are best equipped to get you back on your feet if you experience something like a sprain or strain or a fracture or any other musculoskeletal injury, that's preventing you from doing activities.
Host: Now I'm old hat when it comes to all of those things, but for the fortunate out there who aren't quite as accident prone as I, can you explain the difference between a sprain, a strain and a fracture?
Dr. O'Connell: Yeah, certainly. So, a sprain and strain are sometimes similar, but a sprain is when a ligament, which are kind of bands of tissue that connects to bones usually around the joints, kind of gets stretched beyond their limits, or even can get torn completely. And there can be varying degrees of sprains though. These can range from just a minor injury, with some pain that doesn't have significant damage to a ligament to what we call a grade three injury, where you have a complete tear of the ligament and you kind of lose the loss of function. Now, a strain on the other hand is when you do damage to muscles or tendons, which is, the same mechanism like your joint gets stretched too far or you fall down and twist something.
The tendons and the muscles can get stretched and injured and symptoms from that, you know, you can, from both of those, a sprain and the strain, you can have pain, swelling, sometimes muscle spasms, decreased range of motion of your joint and difficulty with putting weight on your joints. A fracture is really different.
A fracture is definitely a higher energy mechanism or an injury. And a fracture is when the bone is actually broken or cracked and the symptoms are usually more severe. Usually you have more kind of sudden, severe pain with lots of swelling, difficulty putting weight or moving that part of your body.
And sometimes there's even a visible deformity. So, like a visible injury that you can see that the bone is shifted from where it's supposed to be. And rarely, the bone can actually stick through the skin, which would be called a compound fracture, which is pretty severe.
Host: Yeah, that does not sound like a fun thing to have that. Luckily I have not experienced a compound fracture, but as mentioned, I do sprain and strain myself on a, well, I won't say a regular basis, but more often than I certainly would like to. So, and I know I shouldn't just run to the ER, every single time I have an injury. So, if I suspect I might have a mild sprain or strain, what should I do?
Dr. O'Connell: Yeah. I mean, if you suspect a mild sprain or strain, usually I recommend what I tell patients is RICE therapy and I'm sure a lot of people have heard that acronym. But basically stands for rest, ice, compression and elevate. Typically I also tell patients to take an over the counter anti-inflammatory medication, something like a Tylenol or Advil, which can really help with pain and swelling.
And usually after a couple of days of relative rest and activity modification, once the pain is improved, you can kind of get back to doing your normal activities. Sometimes you need to keep the area immobilized or not move it for a certain period of time. But I would tell you to be cautious about immobilization for extended periods of time, because that can cause unnecessary stiffness and scar tissue formation. So that's kind of when we would want you to see a doctor, if you're getting to that point.
Host: Sure. Yeah, that, that makes a lot of sense. Let's talk a little bit more about knowing when we should see a doctor, because I don't have an x-ray machine in my eyeballs. And so at some point in time, there might be a reason for me to go to a doctor. And for me, it probably should be going for doctor, but general advice to the audience. How does one know when a doctor is the next step?
Dr. O'Connell: So, I think initially it would be if the symptoms are really severe from the get-go. So that would be significant swelling, an obvious injury or deformity, like a fracture, an open area or open skin wound. And then other significant symptoms, which would be things like instability or feeling like you can't put pressure on your leg because it's going to give way. A lot of people will come in and say, it feels like their knee is going to give way. Are all certainly things that you should go see a doctor for. And then even if it was something like a mild injury to begin with, but it just doesn't improve after a couple of days of resting it, icing it and using anti-inflammatory modalities than that, that's again, when you should make a trip to your local doc.
Host: So the next time I slip and fall and on the way down, I see the bottom of my foot, not the part of my foot I'm supposed to see. And that's happened before. I know I need to go see a doctor. Where should I go? Where should I go and see a provider?
Dr. O'Connell: Orthopaedics at VCU Health. We have a lot of different locations. We have eight locations actually and all, have the ability to see same day kind of urgent walk-in patients. So, we have seven locations throughout the Richmond and Colonial Heights area, and then a new clinic, which has opened in Williamsburg near William and Mary there.
And all of these locations will have imaging capabilities on site. Some of them even have what we call advanced imaging capabilities, which would be like an MRI machine or a CAT Scan machine. And some of them even have physical therapy, which can really be helpful. And it's kind of pivotal, how we treat patients after injuries and the musculoskeletal system to be able to get you back to your pre-injury level. So, it's really nice having all of those in one location. And when you come see us, we'll explain the treatment options, whether that'd be short or long term, including non-operative and operative strategies if needed.
Host: So, let's walk through the mechanics. Here I am, hobbling in to see the doctor because I think I might have broken something. What should one expect from that initial visit?
Dr. O'Connell: Yeah. So typically if an injury is severe enough where you're, you've made it to an orthopaedic surgeon to get an evaluation; we're typically going to get an x-ray as kind of the first part of the evaluation. And that's to make sure that you don't have a fracture or to evaluate the fracture. And then we'll kind of use that information combined with talking to you and sitting down and examining the injured area, to come up with a treatment plan. Sometimes that's simple things like medications that we prescribe, sometimes it's things like physical therapy. You know, and in the worst case scenario, if it's something that requires surgery, then we'll sit down and discuss what the optimal timing for the surgery is.
Obviously, we want to do it as quickly as possible to get you back on your feet. But sometimes we have to wait until swelling decreases and inflammation goes down before surgery is appropriate to prevent complications after surgery. Sometimes you get something that we call like a splint or a cast which will immobilize the joint or the injury if there's a fracture that we see on x-ray or if it needs more rest to let it heal. And these are things that we can do in the office when you come see us that day as well.
Host: It's been a couple of years since I've been forced to wear the boot of shame from breaking my ankle on more than one occasion. So, refresh my memory. How long does it take before I start to recover?
Dr. O'Connell: So, recovery will be pretty dependent on the type of injury that you have. A minor sprain or strain can typically heal in about two to four weeks after a period of rest with a gradual return to activities. When you have more severe injuries, like a fracture, the bone will typically heal in about six to eight weeks.
So, like if you were in a boot, then typically that the period of boot wearing is about six weeks, but sometimes it takes longer than that to get back to your pre-injury level of activities. And then, on the other end of the spectrum, like, if you have a severe injury that requires surgery, then those can take as long as six months to even a year to recover from.
And, hopefully when we have that initial evaluation and talk about your injury is we can give you a good estimate of when we think that you're going to be back to normal and feeling better.
Host: Great information, Dr. O'Connell. Hopefully others out there aren't quite as accident prone as I am. But if in fact they are, we now have some good solutions going forward. Thank you for your time today.
Dr. O'Connell: Perfect. Thank you, Evo.
Host: Once again, that was Dr. Robert O'Connell an Orthopaedic Surgeon at VCU Health and Assistant Professor in the VCU School of Medicine's Department of Orthopaedic Surgery, specializing in Sports Medicine. Thank you for listening to Healthy with VCU Health.
I have been your host Evo Terra. To learn more about orthopaedic injuries and our same-day clinics, visit vcuhealth.org, and to listen to other podcast episodes from VCU Health, visit vcuhealth.org/podcast.