Sprains and Strains
This month we will look at a topic that is sure to confront every
bowhunter sooner or later. Muscle and ligament injuries can
occur from overuse or sudden trauma. These injuries can range
from mild to severe and may even require surgery.
First we need to discuss a little anatomy and define our terms.
Bones are hooked together by ligaments. Ligaments cross joints
and basically function as living rubber bands which allow your
joints to bend in their normal range of motion. Ligaments also
provide joint stability and prevent the joint from bending in
abnormal directions which could cause a joint dislocation or
muscular damage. Sprain is the term we use to describe injuries
to ligaments. Muscles attach to bone via tendons. Tendons are
like ropes which allow the contraction of your muscles to move
your bones. Tendons also frequently cross joints but are not
a major factor in joint stability. Strain is the medical term
for a pulled muscular tendon injury.
Sprains are injuries to your joints. These injuries
typically occur when a joint is suddenly moved or forced in
an abnormal motion. The classic ligament injury is the ACL ligament
rupture in the knee of skiers. When the joint is forced into
a sudden unusual position the ligaments or "living rubber
bands" are severely stretched. How badly they are damaged
defines the degree of injury. A first degree sprain is a minor
stretch of the ligament. You will typically have minimal pain
and swelling. The integrity of the joint is intact and stability
is maintained. These heal well with minimal treatment. A second
degree sprain is more serious. The stretch is more severe and
there is a partial tear of the ligament. There will be increased
pain and swelling and you typically will develop a black and
blue(ecchymosis) at the site of the injury. This is from the
hemorrhage at the site of the injury. These injuries can lead
to permanent joint pain and instability if not treated appropriately.
Ligaments have a very limited blood supply and heal very slowly.
Improper initial therapy can greatly delay healing or increase
the chances of permanent instability. Third degree sprains mean
that the ligament has been completely torn. There will often
be increased swelling and ecchymosis. The joint will be somewhat
unstable depending on the ligament that has ruptured. The ligament
can not heal back together without surgery.
Treatment of sprains starts with a trip to see your doctor. As
mentioned above these are injuries to your joints and the first
step in treatment is to make sure that there are no broken bones.
In most cases your doctor will get an x-ray and rule out a fracture.
This can be very difficult without an X-ray as the pain and
swelling can make the physical exam unreliable. X-rays only
show bony injuries and do not really help diagnose sprains, such
as this picture to the left of a fractured ankle. The doctor will need to examine your injured
joint for swelling, pain, and ecchymosis. If the pain is not
too severe the physician will stress your joint to check for
instability. This greatly helps to define the sprain and guide
therapy. Often at the initial visit the pain and swelling will
be too great and the joint can not be adequately stressed. In
these cases you will typically be immobilized and rechecked in
3-4 days when the pain and swelling have improved. At this time
the joint can be stressed and further therapy outlined.
Initial therapy is the same for all sprains. Rest, ice , compression
and elevation (RICE) are the mainstays of therapy. These maneuvers
are used to decrease swelling and prevent further injury. Rest
is self explanatory. The amount of time to limit activity is
related to the severity of the injury. In general activity should
be limited as long as the pain is severe. Rehabilitation of an
injury always involves some pain as range of motion is restored
but intense or severe pain is your body's way of telling you
that you are doing too much too soon. In more severe sprains
you may be placed in a splint to further limit mobility and aid
in healing. Ice should be applied to the injured area 3-4 times
per day for 20 minutes at a time. Do this for the first 2 days.
Compression can be maintained with an ACE bandage. These will
often be put on by your doctor. When you reapply them make
sure that you do not stretch the ACE too tightly. This can cut
off your blood supply. The wrap should be minimally stretched.
If the wrap is too tight you may notice pain, coolness or numbness
below the wrap. Loosen it immediately! Elevation should be
used as much as possible for the first 48 hours. Try to keep
the injured area above your heart as much as you can. These
treatments in connection with a visit to your doctor outline
the framework for the treatment for sprains. In first or mild
second degree sprains this may be all that is needed. More severe
injuries will require longer rehabilitation times. Physical
therapy and even surgery may be required depending on the ligament
injured. Even though all third degree sprains mean the ligament
is ruptured, not all require surgery. Even severe ankle sprains
do well with conservative therapy whereas third degree knee sprains
are typically operatively repaired. It also depends on the patient.
Ligamentous shoulder injuries are a problem for bowhunters.
We may elect to have these repaired even though most "normal"
people would not need the repair for everyday living. In these
cases it is worth the effort to see a orthopedic surgeon who
specializes in sports medicine. They have the experience and
training with athletes that is necessary to get you back shooting.
While your orthopedist may not have much experience with archery
he or she will have a very thorough understanding of shoulder
biomechanics and what needs to be repaired and what can be rehabilitated.
Strains are injuries to muscles and tendons. Muscles
are attached to bones via tendons. Tendons function as ropes
which allow contraction of the muscle to move the bone. Strains
result from violent contraction of the muscle or from stretching
the muscle beyond it's normal elasticity. This can cause damage
to the tendon or the muscle itself. Strains are graded very
similar to the system used above for sprains. First degree sprains
are a mild injury to the tendon and or muscle. You will usually
notice pain , swelling and muscular spasm. While it may be painful,
muscular strength is usually preserved. Second degree strains
are the next stage and involve further tearing of muscular fibers
and tendon fibers. There will be a loss of muscular strength
and a black and blue where the muscle bled. Third degree strain
is a complete tear of the muscle or tendon such that the muscle
is no longer properly attached to the bone. There will be a
complete loss of function. Strains are initially treated just
like sprains. A trip to your doctor to grade the strain and
make sure there is no fracture is always worth it. Rest, ice
,compression and elevation are the initial treatment. For mild
strains, gentle stretching exercises can help limit muscular
spasm. Second degree strains will typically require longer periods
of immobilization and some physical therapy. Third degree strains
need to be seen by an Orthopedic surgeon for possible reattachment.
Because muscles have a much better blood supply, strains usually
heal faster and more completely. Your muscles are quite adaptable
and strength training and stretching exercises can completely
rehabilitate most first and second degree muscle pulls. In some
cases even complete ruptures do not need surgery and you can
rehab around the deficit. An Orthopedic Surgeon who specializes
in sports can once again be very helpful in these situations.
While sprains and strains are a somewhat inevitable part of hard
hunting there are things that you can do to prevent them or at
least minimize your injury. A long term weight training program
will increase the strength of your tendons and muscles and provide
increased stability around your joints. Even light weights can
have a very beneficial effect if used consistently. Stretching
your muscles also will prevent many muscle strains. The key
to stretching is to make it a part of your everyday activities.
Increased flexibility will prevent many injuries as well as
make many hunting activities such as hanging a treestand easier.
For weight training and stretching to be successful they need
to be done year round. Starting a week before hunting season
will only make your sore. You will probably get discouraged
and give up. A simple preventative program as well as appropriate
treatment when an injury does occur can minimize your down time.
This will get you back to your activities in the shortest amount
of time and with minimal long term problems.