Sprain vs. Strain: What’s the Difference?

What are Sprains and Strains?

Sprains and strains are two of the most common soft-tissue injuries, which can occur from everyday routines or physical activity. 

A sprain is a stretching or tearing of a ligament– the tough, fibrous connective tissue that joins two bones together at a joint. Ligaments primarily serve to support your joints, by providing stability and preventing hyper-extension.

Typically, sprains result from a shock force that displaces or damages a joint, and can cause severe pain, discoloration, and inflammation. Sprains most commonly occur at the ankle, knee, and wrist joints, and can be classified as mild, moderate, or severe.

Mild (Grade I) sprains are characterized by a slight stretching or tearing of the ligament fibers; moderate (Grade II) sprains involve a partial tearing of the ligament; severe (Grade III) sprains describe a completely ruptured ligament. [1]

A strain is a stretching or tearing of muscle tissue or tendon– the tough, fibrous connective tissue that attaches muscle to bone. Tendons enable skeletal movement by transmitting the forces from contracted muscles to bones and also contribute to joint stability.

Strains often occur from an overuse of a muscle or tendon, and can cause pain, inflammation, muscle spasms and weakness. [2] A strain can be graded using the same three categories as a sprain: mild, moderate, and severe.

How do you know if I have a sprain or strain? 

While sprains and strains may present many of the same symptoms, there are many important distinctions between the two. The majority of sprains result from sudden trauma or tension, whereas strains can either be acute or chronic.

Typically, sprains are accompanied by a sharp and localized pain, swelling, bruising, and a limited ability to move or use a muscle.

With a strained tendon, individuals might experience redness, swelling, limited mobility, muscle weakness, spasms, and a more consistent pain. It is advisable to see a doctor to receive a proper diagnosis. 

Are sprains or strains more serious?

Neither injury is considered worse than the other. Both strains and sprains can cause serious damage to our connective tissues, tendons and ligaments, and can affect our ability to perform daily activity.

However, certain strains may be deemed more serious than other strains. For example, a severe (Grade III) strain will require more aggressive treatment and a longer period of immobilization than a mild (Grade I) strain. The same can be said for a sprain. [2]

Can you make a sprain worse?

Yes, a sprain can worsen if it is ignored or treated insufficiently. It is very important to take every precaution to prevent further stretching or tearing of the connective tissues. For example, carrying heavy items with an injured wrist could possibly worsen the sprain and cause long-term problems.

Common Sprains

Sprains occur most frequently in the ligaments of the ankles, knees, elbows, wrists, and thumbs. 

  • Ankles. Sprained ankles are among the most common injuries, affecting approximately 25,000 individuals in the U.S. every day. [3] This occurs when your foot lands on the ground in an awkward position, causing you to roll or twist your ankle. When this happens, the ligaments that normally keep the ankle stable are forced beyond their normal range of motion, and either stretch or tear. [4]
  • Knees. Knee sprains can occur in any of the four ligaments in the knee (ACL, PCL, MCL, or LCL). They often result from a direct impact to the knee or an unnatural landing on a bent knee, which puts intense pressure and forces on the knee’s ligaments. [5] 
  • Elbows. Elbows are easily sprained as they absorb many of the forces placed on the hands and shoulders. These sprains can occur when the arm is suddenly bent or twisted into an abnormal position or when the elbow is overloaded from a repeated movement. 
  • Wrists. Sprained wrists are usually caused by a forceful impact on the hand, causing the wrist to bend past its normal range of motion. This often happens when we instinctively stretch our hands beneath us to break the landing of a fall.
  • Thumbs. Much like a sprained wrist, thumbs are usually sprained when a strong force bends the thumb backward. This overextension can also happen from landing on your hand to break a fall or from playing a racquet sport, like tennis.

Common Strains

Muscle strains are most common in the hamstring, lower back, neck, and shoulders. 

  • Hamstrings. A hamstring strain, or pulled hamstring, happens when one of the muscles in the back of the thigh is stretched or torn. While this injury is especially prevalent in athletes who require agility and power, it can occur from any activity that overloads the hamstring muscle. [1]
  • Lower back. Lower back strains usually develop from a sudden physical exertion or gradual overuse. This type of strain is most common in individuals who perform repeated heavy lifting or bending over. Strains in the lower back are often accompanied by painful muscle spasms.
  • Neck. There are over 20 muscles in the neck that are responsible for keeping the head upright and supporting movements of the neck, jaw, and shoulders. Neck strains can occur in any of these muscles, and are frequently caused by poor posture, heavy lifting, an awkward head placement, or whiplash from a sudden impact to the body. [6] 
  • Shoulders. Shoulder strains typically result from the overstretching of an inflexible shoulder, repeated overhead arm movement, or carrying something on your shoulders for a prolonged period of time. 

Risk Factors

Both sprains and sprains can happen to anyone. However, there are certain factors and activities that increase the likelihood of developing a soft-tissue injury. 

  • Extreme physical exertion. Activities that place excessive stress on tendons and ligaments, including a sudden or frequent lifting of heavy objects, playing high-impact or contact sports, and overstretching joints and muscles. [7]
  • Physical health. Individuals who are sedentary, overweight, fatigued, or in overall poor physical condition are more prone to injury.
  • Inadequate muscle recovery. Individuals and athletes who fail to warm up or stretch prior to physical activity are more likely to injure themselves as their muscles may not be prepared to absorb shock forces.
  • Footwear. Footwear with insufficient arch support and cushioning could increase the risk of lower limb injury. [8]

Are certain athletes more susceptible to sprains than others?

While the majority athletes are highly susceptible to soft-tissue injuries due to the nature and intensity of their activity, some may be more likely to develop a sprain than others.

For example, football players are more likely to sprain their ligaments than swimmers, as football is a weight-bearing, fast-paced, and high-contact sport. [9] 


It is often difficult to diagnose a soft-tissue injury without the help of a trained medical professional.

Typically, physicians will be able to determine the nature of the injury with an account of the symptoms, an assessment of patient history, and a physical examination of the injury. Sometimes diagnostic tests may also be useful to confirm or rule out conditions. 

In a physical examination, physicians will check the injured area for discoloration and swelling, and evaluate its range of motion, reflexes, and severity of pain. A detailed account of when the pain started could also contribute to a more accurate diagnosis.

In the event that the findings from the physical exam are insufficient for a definitive diagnosis, the physician may order diagnostic tests. These typically include an MRI scan, an ultrasound, a CT scan, or X-ray imaging. 

Treatment and Recovery

Soft-tissue injuries will vary in location, type, and severity. However, with any of these injuries, initial treatment with the RICE method –Rest, Ice, Compression, and Elevation– will accelerate the healing process or even resolve the injury altogether.

Rest prevents further injury and gives the body time to recover; Ice reduces swelling and numbs the area to reduce pain; Compression stabilizes the region and restricts blood flow to reduce swelling; and Elevation reduces swelling, pain, and discomfort.

Nonsteroidal pain medication, either prescription or over-the-counter, may help to further alleviate some of the symptoms.

Moderate to severe soft-tissue injuries may require more aggressive treatment, including immobilization devices, physical therapy exercises, and surgery.

It is important to receive a proper medical diagnosis and treatment protocol. Ignoring or treating the injury improperly may leave joints misaligned or ligaments weakened, which could cause future injury. [7]

Should I visit a doctor if I suspect a sprain or strain?

For mild sprains and strains, it may not be necessary to see a physician. These injuries may improve with several days of conservative treatment.

However, you should seek medical help if you struggle with weight-bearing activity, experience acute pain at the site of the injury, or have any numbness.

Similarly, if you have sustained previous injuries or have a medical condition that puts you at higher risk of injury, you should have the affected joint examined. [8]

Can you walk on a sprained ankle?

Individuals with a sprained ankle should not attempt to walk or put weight on their injured foot. By putting weight on a sprained ankle, you may be further stretching or tearing the ligament and worsening the injury.

A combination of rest, ice, compression, and elevation should be followed, until a medical professional has cleared weight-bearing activity. 


Soft-tissue injuries usually occur when individuals increase the intensity or duration of their physical activity. A number of factors, including conditioning and nutrition, may help to reduce the risk of injury and reinjury. [1]

  • Warm-up. To prevent overstretching or sudden stress on your body, individuals should try to warm up before exercise. This will increase blood flow throughout the body and loosen up the muscles and joints. Warm-ups commonly include walking, jogging in place, or light jumping. 
  • Hydrate. Hydrating prior to exercise will help to regulate body temperature and lubricate joints, tendons, and ligaments.
  • Stretching. Stretching before and after physical activity will help loosen up your joints and muscles, preparing them to resist the impact forces they will encounter during exercise. Stretches should be performed slowly and deliberately. To prevent overstretching, you should not stretch your muscles past their normal range of motion. 
  • Physical and environmental conditions. Choose athletic shoes with adequate arch support and foot cushioning to ensure that shock forces are distributed evenly across the foot. Similarly, avoid slippery or uneven surfaces that could disrupt how your foot lands on the ground. 
  • Cool down. Cooling down after physical activity will help your heart rate return to normal and allow your muscles to recover.
  • Rest. Incorporating rest into your routine will help prevent muscle overuse and give your body time to recover in between workouts. 


  1. “Sprains, Strains and Other Soft-Tissue Injuries – OrthoInfo – AAOS.” OrthoInfo, June 2020, orthoinfo.aaos.org/en/diseases–conditions/sprains-strains-and-other-soft-tissue-injuries/.
  2. “Treating Sprains vs Strains.” Physicians Immediate Care, 3 Jan. 2020, physiciansimmediatecare.com/sprain-vs-strain/.
  3. DerSarkissian, Carol. “Ankle Injuries, Sprains, Strains, and Fractures: Causes and Treatments.” WebMD, 11 Nov. 2020, www.webmd.com/fitness-exercise/guide/ankle-injuries-causes-and-treatments#1.
  4. Mayo Clinic Staff. “Sprained Ankle.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 28 July 2020, www.mayoclinic.org/diseases-conditions/sprained-ankle/symptoms-causes/syc-20353225.
  5. “Knee Sprain.” Harvard Health, Apr. 2019, www.health.harvard.edu/a_to_z/knee-sprain-a-to-z.
  6. Sofianos, D’mitri. “Neck Strain: Causes and Remedies.” Spine-Health, 15 Nov. 2017, www.spine-health.com/conditions/neck-pain/neck-strain-causes-and-remedies.
  7. DerSarkissian, Carol. “Understanding Sprains and Strains — the Basics.” WebMD, 13 May 2019, www.webmd.com/first-aid/understanding-sprains-strains-basics.
  8. “Sprains.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 25 Sept. 2020, www.mayoclinic.org/diseases-conditions/sprains/symptoms-causes/syc-20377938.
  9. “Sports Injury Statistics.” Johns Hopkins Medicine, www.hopkinsmedicine.org/health/conditions-and-diseases/sports-injuries/sports-injury-statistics.

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