We often hear of someone who has sprained their ankle, strained a muscle or dislocated a joint. But what do these types of orthopaedic injuries entail? A sprain can be defined as the overstretching or tearing of the ligaments supporting a joint. Ligaments attach bone-to-bone or cartilage-to-bone. A strain on the other hand is the overstretching or tearing of a tendon. Tendons are flexible, fibrous tissues that attach muscle-to-bone. Both sprains and strains commonly occur as a result of forceful movement beyond a normal range. A dislocation is the complete displacement of a joint from its natural articulation and generally occurs as a result of impacted force.
The Grading System
Sprains and strains can be classified according to how badly a ligament or muscle tendon has been damaged. This classification is referred to as a grading system.
Grade I or first-degree sprain/strain: involves slight stretching or incomplete, mild tearing of a ligament or muscle tendon. This results in little or no instability at the joint
Grade II or second-degree sprain/strain: involves a more serious stretch or tear of the ligaments or muscle tendons, resulting in some looseness and instability at the joint.
Grade III or third-degree sprain/strain: considered to be the most severe, involving complete tearing or rupturing of the ligaments or muscle tendons. This results in complete instability of the joint allowing for little to no weightbearing ability on the joint or effected limb.
Signs & Symptoms
The signs and symptoms of most sprains or strains are very similar, depending on the grade of the injury. Broadly speaking a grade I sprain/strain will result in mild pain, slight swelling, point tenderness and no obvious joint deformity. The location of swelling and tenderness will be indicative of which joint has been injured.
Grade II sprains/strains will present with swelling that may distort the normal contour of the joint and visible deformity may be obvious. Significant pain will be felt when trying to move the joint – indicating disruption of stabilising ligaments or tendons.
Grade III sprains/strains usually presents as a complete dislocation of a joint with noticeable displacement and deformity. Here, supporting ligaments or muscle tendons are often completely ruptured providing very little or no stability to the joint.
The risk factors associated with the above-mentioned orthopaedic injuries are similar and can be classified as either modifiable or non-modifiable.
Modifiable risk factors are those which can be avoided or prevented through intervention, whereas non-modifiable risk factors refer to those over which we have no control.
Non-modifiable risk factors include age, sex and anatomical structure. While reports have indicated that the elderly population are at increased risk of injury associated with poor balance and falling, younger individuals between the ages for 20 – 39 years, show statistically higher injury rates because of their more frequent rate of participation in contact and impact sports. This, however, is a modifiable risk factor.
Modifiable risk factors include participation in contact or collision sports, hard training surfaces, occupational demands and /or weakness of surrounding supporting muscles. All of which are often modifiable through neuromuscular training interventions.
The immediate care of dislocations often falls outside the scope of practice of a Biokineticist as non-operative acute phase management usually involves manoeuvres to reduce the dislocated joints. Once reduced, patients are usually advised to adopt the RICE (rest, ice, compression, elevation) approach for several days post injury followed by complete immobilisation for approximately 3 weeks. The focus of treatment during the acute phase of sprain and dislocation injuries is centred on pain control. As Biokineticists, focus is towards second and third phase recovery of orthopaedic injuries. The second phase of recovery involves restoring range of motion to the joint, regaining strength in the surrounding, supporting muscles and establishing neuromuscular control. The final third phase of recovery should focus on regaining normal strength and returning to full activity.
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