Sprains and strains

Sprains and strains are common weight-room injuries. Here’s how they differ, how to treat them and how to help prevent them.

By Guillermo Escalante, PhD, MBA, CSCS

You feel something pull in your back as you do a set of barbell curls. You strained something. Or did you sprain something? Interchanging the terms “sprains” and “strains” is much like interchanging the terms “superset” and “giant set”; it’s simply inaccurate to do so. While sprains and strains share some similarities, there’s a distinct difference between the two terms. “A sprain is defined as a stretch or a tear [partial or full] to a ligament, which attaches a bone to a bone,” says Dee Tipton, PT, MPH, DD, director of physical therapy at SportsPros, a physical-therapy and personal-training center in Claremont, CA. “On the other hand, a strain is defined as a stretch or a tear [partial or full] either to a tendon, which attaches a muscle to the bone, or to a muscle itself.”

Since weight training involves repetitive stresses as well as dynamic and explosive demands on the muscles and tendons, common sense will tell you that most injuries in the weight room are strains. Sprains occur in weight training too, however, with exercises that tax ligaments at vulnerable joints such as the knee and the shoulder. Both sprains and strains can be kept to a minimum if suggested precautions are closely followed.

Sprains and strains are usually graded as first-degree, second-degree or third-degree injuries. A third-degree injury is a full tear, either of a muscle/tendon (strain) or of a ligament (sprain); the full tear is usually accompanied by significant swelling, loss of movement, loss of function, loss of strength and significant pain. A second-degree injury is a tear that, though large, leaves a significant portion of the fibers still intact; the swelling, loss of movement, loss of function, loss of strength and pain are usually all moderate. With a first-degree injury, a large portion of the tissue is still intact, save for perhaps a few fibers; the pain is usually mild, and the swelling, loss of movement, function and strength are usually all minimal.

Multi-joint exercises such as the bench press, bent-over row, deadlift, leg press, squat and lat pulldown are examples of moves that subject the body to potential strains, but following the listed precautions significantly reduces the risk. In general, avoiding quick or jerky movements when performing these exercises will minimize strains. It’s important to note that these exercises are critical to a successful bodybuilding program, so avoiding them altogether isn’t really a long-term option.

Some of the exercises that can lead to strains can also lead to sprains, but because of the type of stress required to cause a sprain in the weight room, the list is much shorter. The bench press, for one, can cause a sprain to the shoulder joint because of how much stress it places on the ligament between the acromion process (the bony prominence at the tip of the shoulder) and the clavicle in the shoulder. When this ligament is sprained, you can experience significant discomfort while benching, reaching across the body or even touching the affected area of the shoulder.

Squats can cause sprains to the knee. When you do deep squats (i.e., lower than parallel) and you bounce up from the bottom of the range of motion, you put stress on the two bands of cartilage in each knee joint (known as the medial meniscus and lateral meniscus).

When dealing with a sprain or a strain, the initial stage of the rehabilitation program involves resting the injured bodypart for 2–5 days and icing it for 15–20 minutes, 2–3 times per day. Once the pain has significantly decreased, the introduction of range-of-motion exercises (flexibility), manual-therapy techniques (such as joint mobilizations and soft-tissue mobilizations) and therapeutic exercise should be progressively introduced and gradually increased over time. After the acute stages of the injury have passed and symptoms begin to subside, the therapeutic-exercise part of the rehabilitation should be progressed more aggressively, to the point at which the rehabilitation program mimics some of your regular workouts.

Precautions to Prevent Sprains & Strains

1. Begin your workout with a general cardiovascular warm-up for 5–10 minutes to raise your core body temperature and assist in improving tissue extensibility.
2. Perform 1–2 exercise-specific warm-up sets with submaximal loads to get the areas you are about to train ready for heavier loads.
3. Frequently alter exercises, exercise order, exercise volume (ie., reps multiplied by sets) and loads.
4. Pay close attention to your body and ensure that no sharp, isolated pain is present when you’re performing an exercise.
5. Allow plenty of rest (at least 48 hours) between workouts for the same bodypart.
6. Avoid taking every set of every workout to complete muscle failure.

Rating Your Sprain or Strain

First Degree

Defined as a partial tear of some fibers (muscle and tendon fibers for strains, ligament fibers for sprains). About one-third of the fibers remain intact.

Second Degree

Defined as a larger partial tear of the fibers (muscle and tendon fibers for strains, ligament fibers for sprains). More than one-third to nearly all of the fibers are torn.

Third Degree

Defined as a full-thickness tear of the fibers (muscle and tendon fibers for strains, ligament fibers for sprains). No fibers remain connected and this injury usually requires surgical intervention.