Strain or Sprain? What’s The Difference?

Sprains and strains are common musculoskeletal injuries. These types of injuries are usually sustained from some type of physical trauma to the soft tissues or in rare cases, by over activity.


The Difference

The major difference between a sprain and a strain is the type of soft tissue is that is injured. A sprain occurs to a ligament whereas a strain occurs to a muscle belly or its tendon. Tendons and ligaments are different types of tissues with different functions. A tendon connects a muscle to a bone and a ligament connects a bone to a bone.

The severity of injury to a tendon or ligament is graded by three degrees. The anatomical damage is an abnormal stretching or tearing of the structure. The following identifies how sprains and strains are graded:


  • A grade 1 strain usually causes stretching of a few of the muscle fibers.
  • A Grade 2 strain has more significant damage, and some muscle fibers are damaged or torn.
  • A Grade 3 strain is a complete rupture of the muscle.


  • Grade 1 sprains occur when fibers of the ligament are stretched but not torn.
  • Grade 2 sprains are injuries where the ligament is partially torn.
  • Grade 3 sprains occur when the ligament is completely torn or ruptured

Interestingly, the signs and symptoms of each type of injury are relatively similar. The most common symptoms are the pain, swelling, muscle spasm, and internal bleeding.


1. What are the signs and symptoms of sprains and strains?
Interestingly, the signs and symptoms of each type of injury are relatively similar. The most common symptoms are the pain, swelling, muscle spasm, and internal bleeding. This can be seen through the bruising around the area of the injury. In extreme cases, bruising can spread far from the actual injury site.

2. How are sprains and strains diagnosed?
There are several ways to evaluate and grade these soft tissue injuries. The clinical presentation of the injury is one of the keys in diagnosing the degree of damage as well as a good history of how the injury occurred. The amount of pain the injured person reports on a pain scale, the amount of swelling in the area, the amount to bruising observed, and the degree of muscle spasm are important factors in making a diagnosis.
There are also special clinical tests a physical therapist can perform to help identify the extent of the injury. These tests evaluate the stability and laxity in the affected joint and are then compared to tests of the uninjured side. The more laxity or play within the joint the greater the damage to the soft tissue. In certain cases, an MRI may be required.

3. How do sprains and strains heal?
After a period of time following the injury, the body will begin to lay down scar tissue to the injured structure. The scar tissue will help in making the structure more solid. When scar tissue is forming, the fibers are not laid down in the same fashion as the original tissue. Scar tissue fibers tend to be set down in a random formation and somewhat uneven. Scar tissue can never replace or have the integrity as the original tissue.

4. Which heals faster?
A muscle strain will always heal faster than a ligament sprain. This is because muscle has a blood supply which helps in the healing and repairing process.

5. How are sprains and strains treated?
Treatment depends on the degree of injury. Treatment of grade 1 injuries is usually treated conservatively with rest, ice, compression and elevation. (RICE) Some grade 1 injuries will require some physical therapy interventions and grades 2 and 3 will always benefit from therapeutic interventions, however, some grade 3 sprains may require surgery.

6. How can physical therapy help?
Physical therapy can help in many ways from diagnosing the injury and referring you to the appropriate type of doctor to actual physical therapy interventions and treatments.

7. What are some interventions and treatments made by physical therapists?
The following is a list and description of some common treatments.

  • Deep friction massage (DFM) In this type of massage the tendon or ligament is massaged to prevent adherent scaring and to smooth out scar tissue fibers to make them more effective and more like normal healthy tissue.
  • Ice cup massage – during this intervention the goal is to reduce the inflammation in the tendon of ligament itself. The ice is rubbed directly on the injured structure making it a very localized treatment.
  • Soft tissue mobilization (STM) this treatment will help with muscle strains by improving blood and oxygen flow to the injured muscle.
  • Restoration – physical therapy helps restore deficits caused by the injury.
    Physical therapy can help restore:
  • Range of motion (ROM)
  • Muscle strength
  • Muscle length
  • Joint mobility
  • Joint stability
  • Proprioception
  • Balance
  • Gait pattern
  • Normal function leading to return to sport or activity

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