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Ligament sprain - what is it, causes, symptoms and physiotherapy treatment

Ligament sprain - what is it, causes, symptoms and physiotherapy treatment

A ligament is composed of dense fibrous bundles of collagenous fibres and connects one bone to another one, binds organs and the body as a whole.

Ligaments strengthen joints in the human bodies, including the smallest (ex. digital or finger joints) and the biggest joints (hip joint, knee-joint), keeping them in the correct position and adjusting the range of motion.

Externally influenced (e.g.: a sudden fall, twist or impact.), ligament can be stretched or torn. Its not necessary called a sprain, because any relative - injury implies damage of both collagen and elastin fibers. The matter is that, when damaged all types of fibers which make up the ligament, – we can call it as “ligament rupture”, but when there is a partial laceration, we can call it as specific-organ ligament injury (e.g. knee strain, sprain of ankle). So ligament sprain is, basically, partial rupture of ligament, which can be treated.

Reasons of ligament sprain

The main reasons of ligament sprain are trauma – sport injury or home accident. The sprain occurs when, in a joint which is fixed by ligaments, a twitch and / or inappropriate movement is made. That’s why active or strength sport (football, basketball, volleyball, weight-lifting) often cause ligament sprain.

An avulsion fracture occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone This can occur at the ligament by the application of forces external to the body (such as a fall or pull).

Fractures are not obligated complication in ligament sprain, but the sprain is usually occurs in fractures and joint dislocation.

Ligament sprain doesn’t necessary complicated with fracture, but fracture is usually complicated with ligament sprain.

Key symptoms of ligament sprain

  • Severe pain in the damaged area, the ache getting worse in any attempt to move by injured joint and to pressure on damaged ligament. The pain rises in ligament sprain because small nerves, which surround the ligament, are got torn. The nerve endings injury can provoke numb feeling in the damaged area;
  • Swelling, in the damaged limb. The swelling «surrounds» the injured joint (of the limb) and grows rapidly. In the injured area can occur redness and the rise of skin surface temperature – which are non-specific signs of aseptic inflammation (doesn’t imply pathogenic germs), complicating sprain and starting as human body response to the injury;
  • Restriction in joint movement is caused by reflex skeletal muscle spasm in the damaged area, occurring for the prevention joint(s) of the further dangerous movement. For example, in case of ankle sprain, its hard and painful to step by the injured foot, in case of stubbed shoulder is almost impossible to raise the damaged hand;
  • The appearance of a hematoma in the area of ligament sprain. Hematoma occurs due to rupture of small blood vessels, penetrating the ligament, complicated by subcutaneous hemorrhage. In the case of sprained, ligament, opposed to ligament rupture, hematomas do not always occur, it often looks like subcutaneous bruises (intermuscular bruises rarely occur, intraarticular ones are extremely rare). A hematoma can appears not only at the time of the injury, but also gradually «leaks» within 2-3 days after its occurrence;
  • A signature «popping» sound which occurs when a ligament is damaged. Usually the sound is heard in a complete rupture of the ligament. In ligament sprain the sound can occurs but it’s not a specific symptom of the injury.

The symptoms of sprain are very similar to those of fracture, so it is not easy to define this or that disorder without a special examination. Hallmark signs of a fracture are shortening and deformation of the affected limb, complicated by a violation of its axis.

Ligament sprain can be diagnosed with the following methods:

  • magnetic resonance imaging (MRI) of the damaged joint;
  • ultrasound examination (ultrasound) of the joint and its surrounding soft tissues;
  • x-ray of the joint (unlike MRI and ultrasound, x-ray examination does not make it possible to visualize the ligaments, but helps to exclude a fracture and see indirect signs of sprain).

Ligament sprain : treatment

Symptoms of sprain identify the disorder treatment method which implies: pain relief, swelling reduction and ensuring of freedom of movement.

Nonsteroidal anti-inflammatory drugs (NSAIDs) ensure both analgesic anti-inflammatory effects in the treatment of sprain. Depends on the pain intensity, NSAIDs can be used as external (balm, analgetic gel) or internal use (medications, analgesic powder, intramuscular injection). Treatment course is, usually, lasts for 6-8 days and, usually, it’s enough for resolution of infection. A longest course of the treatment may results in side-effects (mucosal erosion and stomach ulcer, kidney or liver disease).

To reduce swelling is possible by applying ice-pack or cold compress the target area for 10-15 minutes every 3-4 hours. Additionally , in order to reduce swelling, in the first days after injury its recommended to elevate of the injured area above the level of patient’s heart will help to maximize the fluid drainage away from the injury.

In the case of the formation of an extensive hematoma, therapy for sprains may also include the appointment of creams and ointments containing direct oral anticoagulants (DOACs) (drugs that reduce blood clotting). The use of DOACs promotes faster resorption of hematoma, normalization of microcirculation and prevention of the formation of venous thrombi in the damaged area. But patient should not use such DOACs if there is a risk that medication intake can result in increased bleeding, or the integrity of the skin is broken, or there are some skin diseases in the place of the intended application.

In the treatment of ligament sprains, an important point is the immobilization of the damaged joint. The immobilization can be achieved by applying a special device that keeps muscles in place and enables the recovery to be maintained – an orthosis.

In a light ligament sprain, which didn’t cause any joint restriction, the treatment can be provided by soft or semirigid orthosis (orthosis with locking plates) or elastic bandage. When applying orthosis or bandage is important to provide support for the damaged area, but not squeeze soft tissues because overly- tight orthosis or bandage causes poor blood circulation in the target area and provokes swelling. Immobilization should be conducted under of your doctor and usually lasts for a week or a month.

Other methods of ligament sprain treatment

Recently kinesio taping has become popular as a treatment method of ligament sprains – it is a special taping technique of applying therapeutic – elastic tapes on a damaged area. The therapeutic effect of kinesio taping are the increase of blood microcirculation andlymph flux in the injured area, support joints in movement and relax overused or tired muscles.

One of kinesio taping advantage is that on the one hand, damaged joint is fixed , on the other hand, patient can move by it. Disadvantages of the method is its cost; the tapes can only be applied by a specialist who has graduated from special treatment courses; taping can’t be used in the following cases: the patient skin is damaged ; deep vein thrombosis of the lower limbs; severe kidney and cardiovascular pathology; complicated forms of diabetes mellitus.

Recovery treatment should start out of acute phase. It implies physiotherapy exercises, which help to normalize the tone of muscles, weakened during the period of immobilization, and restore the initial volume of movements in the joint. Do not forget that the exercises should be carried out under supervision of physical medicine and rehabilitation physician , otherwise exercises can cause pain in ligament .

In order to restore motor activity as soon as possible after the relief of inflammation in sprains, it is also recommended to take medical massage in a course of 8-10 procedures. To avoid undesirable consequences, the procedure should be carried out by medical practitioner.

Additionally we should say about physiotherapy which can be a solution if you are looking for an answer for quick ligament recovery. Physiotherapy helps to reduce swelling and pain in ligament sprain, promotes faster hematoma resolution, stimulates healing of damaged tissues, minimizes term of immobilization and restore skeletal muscle tone so that to provide faster recovery after the sprain.

The treatment course of should starts not earlier then in 3 (three) days after the patient has got the disorder. In the first three days, after the sprain, a hematoma is forming in the damaged area, so any treatment that increases peripheral blood flow can provoke the increase of the hematoma in size.

In ligament sprain, a number of physiotherapy procedures are used. And, usually, the medical practitioners advices magnetotherapy (PEMF Therapy) for the treatment of the affected area. Magnetic therapy has shown good effects , along with : analgesic, decongestant and anti-inflammatory effects in the treatment of the injury.

Treatment of ligament sprain

Nowadays you can use PEMF Devices either in a hospital, or at home. There are a number of portable home-use PEMF Devices which can be used for the treatment of ligament sprain.

Besides portable , there are portable cryotherapy devices which provide physiotherapy treatment of the disease.

Cryotherapy is a method of physiotherapy based on the beneficial effect of cold on the body. As mentioned above, from the first minutes of the injury, it is advisable to apply an ice pack to the injured limb in order to reduce local swelling and pain. When you press a bag of frozen peas on a swollen ankle, you are treating your pain with a modern (although basic) version of cryotherapy.

Cooling the damaged area contributes to the development of analgesic, anti-edematous, antispasmodic, anti-inflammatory, hemostatic (hemostatic) effects, which is important for the treatment of sprains.

Do not forget that carrying out treatment procedures, using portable PEMF devices at home, does not require medical education and special skills, but has a number of contraindications. So, in order to avoid undesirable consequences, it is recommended to consult with your doctor before purchasing the device.

In the subacute period of ligament sprain, it is possible to use phonophoresis with hydrocortisone, this method enhances the effect of magnetic therapy. In recovery, in the case of the maintenance of pain syndrome, Shockwave therapy is used, - this therapy promotes the regeneration of damaged tissues and relieves the residual pain syndrome characteristic of sprains.

Last but not least, its better to prevent the disorder that to treat ligament sprains: wear comfortable shoes, try not to do sudden movements and etc.