Strains / Sprains

Pulled muscles (strains) and partially-torn ligaments (sprains) are by far the most common causes of back and neck pain.  They’re caused by activities that can range from lifting a piano, to turning rapidly or simply bending over.  Pain may begin 1-2 days after the injury, when swelling increases enough to cause pain, so the person may not even remember what they’d done to hurt themselves.

Strains & sprains get better on their own.  It may take just a few days, or the pain may last weeks or months, depending on how bad the injury was.  It can be impossible to tell.

When a strain or sprain happens in the back, the neck, or an arm or leg, it’s easy to understand that a muscle or ligament is involved.  But there are muscles & ligaments all over our body.  If a strain or sprain happens on the left side of the chest, the patient may be afraid they’re having a heart attack (see Chest Wall Pain).  If it happens in the belly, they may worry it’s appendicitis or some abdominal disease.  Neck strains & sprains can cause headache, leading the person to think they have cancer or bleeding in the brain.  Nope.

We diagnose sprains & strains by making sure no other condition exists, like bone disease (cancer, infection, etc.), slipped disks, spinal stenosis, or arthritis.ย  We only get an x-rays or MRI if we’re in doubt. it might be something more serious.ย  We diagnose sprains & strains in the chest or abdomen by ruling out more serious illnesses (often by history & physical exam alone), & by finding tenderness to touch, or with movements.ย  See topic Musculoskeletal Pain, which explains how we distinguish pain from bone, ligament, joint, muscle, etc.ย  There are no x-rays to diagnose sprain or strain.

Treatment is mostly waiting until it gets better; often just knowing the cause of pain (i.e. nothing serious) is a major help.  But patients can take various pain medications (mostly over-the-counter), use ice if it helps, or heat if that seems to help better, and rest (unless that’s impossible), etc.  This is why our website’s focus is just on Diagnosis.

Once in my small ER, I lost face when a patient was angry I hadn’t ordered an x-ray.  I tried to explain it wasn’t useful, & he said, “Two years ago they did an x-ray, & found a bad muscle strain!”  Since that’s impossible, what must have happened was they made the diagnosis because the x-ray was normal, but didn’t tell that part of it.  Annoyed me to no end. And of  course they said “bad” strain, so the patient would feel justified in having pain.  If they’d said a “minor” strain, the patient might have felt put down.

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