Sprains

A sprain is an injury to a ligament — the strong, fibrous band of connective tissue that connects one bone to another and stabilises joints. Sprains occur when a joint is forced beyond its normal range of motion, overstretching or tearing the ligament.

**Severity grading:** - **Grade I (mild):** ligament fibres are stretched but not torn; mild pain and tenderness; joint stability maintained; full recovery in 1–3 weeks - **Grade II (moderate):** partial tear of the ligament; moderate pain, swelling, and bruising; some joint instability; recovery in 3–8 weeks - **Grade III (severe):** complete rupture of the ligament; marked pain, swelling, and bruising; significant joint instability; may require surgical reconstruction

**Common locations and mechanisms:** - **Ankle:** the most common site — inversion injuries (rolling the ankle inward) damage the lateral ligament complex (anterior talofibular, calcaneofibular ligaments). Can occur during walking on uneven ground or landing awkwardly - **Knee:** medial or lateral collateral ligaments sprained by pivoting or direct blows; anterior cruciate ligament from sudden deceleration or landing from a jump - **Wrist:** falling on an outstretched hand — scapholunate ligament; ulnar collateral ligament of the wrist - **Thumb:** skiing (skier's thumb) — ulnar collateral ligament of the first MCP joint from forced radial deviation

**Risk factors:** - Slippery, uneven, or unstable surfaces - Muscle fatigue — tired muscles provide less dynamic joint protection - Poor footwear or sporting equipment - Prior sprain in the same joint (the most important predictor of re-sprain) - Insufficient warm-up and neuromuscular conditioning

*Note for children:* Growth plate cartilage at the ends of long bones is weaker than ligaments, so children are more likely to sustain a fracture (growth plate injury) than a Grade III ligament sprain with the same force.

**Acute management — RICE:** - **Rest:** protect the joint; use crutches if weight-bearing on an ankle sprain is painful - **Ice:** 15–20 minutes every 2–3 hours for the first 48–72 hours - **Compression:** elastic bandage to control swelling - **Elevation:** above heart level

After the acute phase, physiotherapy rehabilitation focuses on restoring range of motion, strength, balance, and proprioception — essential for preventing re-sprain. Return-to-sport criteria should be met before resuming full activity.

For chronic ligament laxity or incompletely healed sprains, prolotherapy (dextrose injection) and platelet-rich plasma (PRP) stimulate fibroblast activity and collagen repair. Persistent ankle instability may ultimately require lateral ligament reconstruction.