Strain vs Sprain

Though commonly used terms, strain and sprain are often used confusingly or interchangeably in the media. While seemingly small distinctions, it’s important to define the differences in terms and clarify one important common misconception about them.

A strain is an injury to a muscle or tendon. A sprain is an injury to a ligament. Players strain their hamstring muscle or Achilles’ tendon and sprain the ligaments in their knee, ankle or shoulder. By definition, a strain or sprain is a tear of the fibers of the muscle, tendon or ligament, even injuries of the mildest grade.

There are three grades of strains or sprains. A Grade 1 injury involves stretching and micro-tearing of tissue fibers. They’re commonly referred to as muscle pulls or mild ligament strains. Grade 2 injuries encompass a wide range of partial tearing of tissue fibers, from just a small percentage of the structure to a large percentage and are usually accompanied by swelling and bleeding within the structure itself. Grade 3 injuries are complete tears or ruptures of the muscle, tendon or ligament. A torn ACL, ruptured hamstring, bicep or pectoral muscle and torn Achilles’ tendon are all examples of Grade 3 injuries.

Hamstring/Quadricep/Calf Muscle Strain

Muscle strains are among the most common football injuries. Frustratingly, they’re also associated with unclear recovery timetables and the risk of recurrent and more severe injuries when players return to play before they’re 100% recovered.

There is no standard return to play expectation after a muscle strain. The percentage of muscle fibers torn, proximity of the tear to the tendon, amount of bleeding within the muscle belly and the rapidity at which a player usually heals all factor into the vague timetables reported by the player and his team. While we often hear that players with Grade 1 muscle strains are expected to recover in 0-2 weeks, Grade 2 strains 2-6 weeks and Grade 3 strains 4-8 weeks or longer, teams re-evaluate these injuries on a week-to-week basis.

Players are considered safe to return to football-related activity when they can function without pain or tightness and the injured muscle is around 90-95% as strong as the healthy muscle on the other side. Still, players are at high risk of re-injury in the first few days after returning and a recurrence of the muscle strain is often more severe than the initial injury. Cascade injuries – an injury that occurs when an athlete has unconsciously stressed another part of his body to compensate for a previous injury – are another potential consequence of an early return to play. In general, you should be wary of a player who returns at the most optimistic end of his recovery timetable.

Important Factors Impacting Return

Some players (or teams) may choose to push the limits of recovery and risk aggravating an existing injury in a critical game, especially if there’s not a capable backup on the roster. Outside of such circumstances, three questions can help determine whether a player may be returning from a muscle strain too soon.

1. Is the player returning near the early end of his expected time of recovery?

NFL players re-aggravate hamstring injuries nearly 33% of the time, according to this study. Re-aggravations occur most often within the first ten days of return to play and the aggravated strain is often worse than the original injury. That’s likely because an NFL player is generally allowed to return to full football related activity when the injured muscle has recovered to about 95% of full strength (when tested against the opposite side of the body isometrically). A player returning at the early end of his expected recovery, then, is either an extremely fast healer or is pushing the limits of expectation. Without the benefit of hindsight, you’ll not know which. Consider an early return a red flag, unless…

2. Has the player made it through one or more football-related drills or a full practice without evidence of a setback?

A successful return to football related drills doesn’t guarantee that a player won’t re-aggravate a muscle strain.  But making it through successive practices is a strong suggestion that the muscle in question has fully healed and is less likely to be prone to inflammation, tightness or more micro-tearing immediately after returning to play.

3. Does the player have a known history of muscle injury, re-aggravations, conditioning issues, or cascade injuries?

Some players are “tighter” than others. There may be a general lack of flexibility, a lesser innate sense of how to protect themselves when a hit is coming or when they extend their bodies, or something in the makeup of their tissue that increases the likelihood that they will tweak a muscle. A player with a long history of muscle strains or a player who’s already had a re-aggravation of his current injury should be considered a higher risk upon his return.

Categories: Navigating Injury Report Series

Tags: andre johnson, calf strain, groin strain, hamstring strain, muscle strain, return to play, sprain, strain