What is a sprain?

Synonyms in a broader sense

Distortion, twisting

English: sprain


The sprain is one of the most common sports injuries. The cause of the sprain is a violent overstretching of a joint, whereby internal structures such as ligaments or the joint capsule are damaged. The large, frequently used joints such as the hand, foot, knee and above all the ankle are particularly affected (supination trauma). The sprain is usually accompanied by swelling, pain, and sometimes a bruise in the area. Most therapy can be limited to cooling the injured joint, immobilizing it, and elevating it. After a few days, the patient should be symptom-free again.

Epidemiology / how often does a sprain occur?

The sprain becomes the Sports injuries calculated, since it normally develops in the context of sporting activities. It is one of the most common sports injuries there are, with the clearly preferred localization of the sprain being the ankle (i.e. the joint between foot and lower leg).

Illustration of a sprain

PECH scheme

Sprain (distortion) -
Ligament or joint capsule
Tape -
Joint capsule -
Articular capsule

1 - 1 - Upper (proximal)
Wrist -
Articulatio radiocarpalis
2 - 2 - lower (distal)
Articulatio mediocarpalis
3 - 3 - knee joint
Articulatio genus
4 - 4 - Upper ankle -
Articulatio talocruralis
5 - 5 - Lower ankle -
Articulatio talocalcaneonavicularis

PECH rule
Break Ice Compression Elevation

You can find an overview of all Dr-Gumpert images at: medical illustrations

Causes of Sprains

Exercise as the leading cause of a sprain

The cause of a sprain is an external force on the joint. Normally, the joint is sprained when suddenly and unexpectedly an unconscious movement occurs that goes beyond the physiological mobility of the joint.
The most typical example, which is known to almost everyone, is the "twisting" of the foot, in which the ankle is overstretched. This often happens in sports like soccer, tennisBasketball or those that involve running or jumping on uneven ground. You can also see sprains of the knee joint in the Soccer not uncommon, as this joint is common, especially in fouls twisted becomes.
Sprains of fingers and wrists, on the other hand, are more likely to occur in sports such as volleyball or skiing. In all these cases, the two surfaces of the joint are displaced against one another and the capsule and / or the ligaments that are involved in the joint are damaged as a result.
The extent of the damage can be a sprain vary greatly. Sometimes the joint structures are only slightly to moderately overstretched, but then resume their normal position and functionality. In the event of more pronounced violence, the ligaments or even the joint capsule can also tear. Frequent sprains of a joint can later be seen as the "cause" for further sprains, since the ligaments practically wear out due to the regular overstretching and are then more prone to suffering further injuries.

Symptoms - This is how you recognize a sprain

The main symptom of the sprain is the pain, sometimes very severe. This mainly occurs when the patient moves the joint. It may even be that the pain is felt to be so severe that the joint can no longer be moved, but then there is usually a more severe injury such as a Broken bone in front. In the case of a pure sprain, on the other hand, the joint should still be able to withstand at least a minimal amount of load despite the limited functionality. The restricted movement can also be caused by the fact that the area of ​​the sprain usually swells up relatively quickly. Since the joints are normally very well supplied with blood, violent impact can also tear blood vessels, which then results in a bruise on the affected area (Hematoma) you can see.

Diagnosis - What does the doctor do?

The diagnosis is provided either by the person concerned or by the doctor, whereby the typical symptoms are usually sufficient as a basis. If the joint is swollen, painful and discolored blue (due to the bruise), but is still slightly resilient, it can be assumed to be a sprain.
Knowing exactly how the accident took place is also useful for making a diagnosis. However, when there is uncertainty as to whether it is actually just a sprain or not something worse than one Torn ligament or a broken bone (an indication of this is, for example, the formation of a hematoma that does not go away for a long time), the doctor can add further diagnostic measures. These include, on the one hand, a detailed physical examination and, on the other hand, imaging procedures such as one X-ray, one Computed Tomography (CT) or one Magnetic resonance imaging (MRI).

Localization of the sprain

Sprains often occur as a result of falls or injuries in sports. Typical injuries include:

  • the wrist
  • the thumb
  • Foot or ankle
  • the toe
  • the knee

The wrist sprain

Especially with ball athletes as well as skiers and snowboarders, the stuck wrist is a widespread phenomenon.
A sprain of the wrist occurs when the joint is overstretched. Basically, this can happen in both directions, but overstretching the joint towards the back of the hand is more often injurious.
Since the pain felt and the extent of the swelling do not necessarily have to correspond to the severity of the injury and there is always the risk of a bone fracture, you should consult a doctor and at least have an X-ray taken.
One of the two forearm bones as well as the small bones of the metacarpal may have been affected. If that is not the case, the sprained wrist is splinted or bandaged. Make sure that the bandage is tight enough to provide support, but loose enough not to interfere with blood flow or nerves. If the fingers become white or begin to tingle or become numb after applying the bandage or bandage, these are clear signs that the bandage is too tight and needs to be re-applied. With good splinting and relief, a wrist sprain usually heals completely within a period of about 10 to 14 days.

Read more on the topic: Sprain of the wrist

Sprain on the thumb

A thumb sprain is usually caused by an unnatural outward movement of the thumb or strong pressure and simultaneous compression from above, as can easily happen with flying balls. It is therefore also one of the classic sports injuries.
The so-called saddle thumb joint, which lies at the direct transition between the hand and the thumb and is responsible for a large part of the movements of the thumb, is most frequently affected.
As with all sprains, the optimal therapy consists in cooling and relieving the joint. The latter is best done with an elastic bandage or a special tape. Taping is also a great way to prevent re-sprains if you are playing a high-risk sport such as volleyball. The tape stabilizes the joint and makes it more resistant to repeated injuries.

Sprain of the knee joint

A knee sprain is more of a twist in most cases. Nonetheless, doctors often use the term "distorsio" to refer to both a sprain and a twist. The term distorsio actually means twisting.
Athletes who make quick start-stop movements are particularly at risk, for example footballers or skiers. In the event of a knee sprain that is accompanied by swelling, you should always seek medical advice, as a layperson cannot distinguish whether the knee is "only" sprained or, for example, a meniscus, cruciate ligament, inner or outer ligament tear .
Since the treatment of the injuries just mentioned differs blatantly and in each case a control with the help of an imaging procedure (e.g. X-ray, CT, MRT) must be carried out, one should seek medical care. The attending physician can also define a scheme according to which the knee - should it only be sprained - should be treated and spared and decide when another sporting activity is okay. In order not to unnecessarily endanger and stress the joint, you should absolutely adhere to these instructions.

Sprain on the foot / ankle

The sprain of the foot, or more precisely the ankle, is the most common of all sprains. The cause is usually a so-called supination trauma, i.e. the twisting of the foot to the side.
The upper ankle in particular is at risk from injuries. It is not uncommon for a sprain to occur in combination with a tear in the syndesmosis ligament or a fracture in one of the lower leg bones. For these reasons, one should consult a doctor after twisting the foot, which is accompanied by severe pain and / or severe swelling.
With the help of an X-ray (and possibly a computed tomography or magnetic resonance tomography) it can be safely excluded that serious injuries are present.
Nonetheless, an isolated sprain of the foot should also be treated adequately. Depending on the degree of severity, you can leave it with cooling and a subsequent support bandage with elastic bandages or a special tape or, in more severe cases, use an ankle splint or even a lower leg cast. A plaster of paris is only necessary in very severe cases and then usually only for a few days. Whereas a splint (a so-called ankle orthosis) is not used that rarely. After healing, the ankle is in most cases as stable as before. Only in individual cases does a slight feeling of insecurity remain.
After several consecutive sprains of the ankle or after an injury that has not healed properly, permanent instability in the joint and the joint capsule can easily occur.
The ankle capsule, which is supposed to stabilize the movements of the foot, warps and loses tension. As a result, the affected foot is at greater risk of kinking and re-sprain. Unfortunately, these frequent second or third injuries can then, in the last resort, lead to early arthrosis of the ankle due to the permanent incorrect loading of the joint, which can then no longer be reversed. In individual cases, frequent twisting injuries are therefore a reason for an operation to tighten the ligaments and the capsule again and thus minimize the risk of osteoarthritis.

Read more on the topic: Sprained foot

Sprain on the toe

A toe sprain is a minor injury, but not necessarily less painful than others.
A toe sprain is not always a sports accident, it can also happen in everyday life.
In order to reduce the pain and to give the sprain the opportunity to heal well, a bandage or tape bandage is useful. Both can be wrapped so narrow that normal footwear can still be worn. When running, those affected will quickly find a technique that will reduce pain. This is perfectly fine and even desirable, as it can relieve the toe.
Care should be taken not to take this gentle cycle for too long, as otherwise there is a risk of incorrect posture and unnatural stress on the bones and joints, which in turn can lead to problems. A toe sprain usually heals in a few days without consequences. However, if a patient notices pain or problems after more than a week, he should consult a doctor. Maybe the toe is broken after all, or there is another problem going on.

Read more about this under Sprain of a toe

Therapy for a sprain


The therapy of sprain depends primarily on the severity of the injury, but also on the age or the individual needs of the patient. For example, it will be more important for a young competitive athlete to regain the full resilience of the joint than for an older person who may no longer move as much on foot anyway.

This is especially important with a sprain First aidwhich usually takes place directly at the site of the injury. The treatment is carried out according to the so-called "PECH rule“:
The "P" stands for Break. The joint should not be subjected to any further unnecessary stress in order to avoid further damage and an increase in pain. It is best to stop immediately with the previous activity and to keep the affected extremity still. The "E." stands for ice. Cooling down should be provided as soon as possible after the injury. This can take the form of ice packs, cold spray, cold compresses or compresses. As a result, the vessels contract, the affected area has less blood supply, and the development of a hematoma and the resulting swelling becomes less likely. The pain is also relieved by cooling. However, one should make sure that ice is not in direct contact with the skin comes to prevent local frostbite. Treatment with heat or alcohol on the affected area should be avoided for at least the first 24 hours.
The "C." stands for Compression. In addition to cooling, it is advisable to put on an elastic compression bandage. The pressure exerted regionally also ensures that less blood flows through the tissue. The bandage also helps stabilize the damaged joint.
The "H" stands for Elevation. The injured area should definitely be elevated. This again reduces the blood flow due to gravity. In principle, the extremity can be placed on top of any object; if nothing suitable can be found, another person present can simply hold up the extremity. However, he should be careful not to move the joint so as not to cause additional pain to the person concerned.

For further therapy, which normally does not exceed one to two weeks, practically the same rules apply as for first aid, all of which have the purpose of protecting the joint. It should be refrigerated and stored up as often as possible. If a bandage is needed at all, a simple one is sufficient Tape bandage or one elastic bandage. A decongestant and cooling ointment may be used to relieve symptoms and sometimes even speed up healing.

However, if the sprain is accompanied by permanent damage, these conservative (i.e. non-surgical) measures are not sufficient to achieve final healing of the joint. Surgery should be performed to restore the ligaments and / or capsule to full functionality. Surgery can also be performed to prevent joint instability (for example, worn out ligaments), which is particularly desirable for people who are active in sports. Then the rest period of the affected extremity is extended to about 4 to 6 weeks.


Since the sprain occurs most often during sporting activities (see also: Sports injury), prevention is also the most important in this area. Before exercising, there should always be a warm-up program that has a pronounced strain and loosening of the joints that will be stressed later. In addition, a level of training appropriate for the activity is recommended, as movements that the joint is not aware of to such an extent are more often not tolerated. Many sprains can also be avoided with the help of appropriate equipment. For example, you can wear shoes that are over the ankle go out and protect him thereby or bandage or tape joints. This should especially be done when the joints are already loaded.

Duration of the sprain

The duration of a sprain is usually between one and several weeks, depending on the extent of the sprain and accompanying injuries.
The acute phase, in which a lot of cooling should be carried out, usually extends over a period of around 48 hours. At this stage the injury is still very fresh. Then the affected area slowly begins to swell. Those affected can use ointments or creams that stimulate blood circulation, which can help remove swelling and any bruises that may be present more quickly. In the case of minor sprains, things can now be done very quickly: the injury improves day by day and within a week most patients can report that they are free of pain.
In order not to take any risks, one should be patient with sporting activities for about a week after the pain relief has occurred. Afterwards nothing stands in the way of that.
The situation is different with severe sprains or even combined injuries. These usually require long-term immobilization after the first acute phase. A duration of around 2 to 3 weeks can be assumed.
If the sprain has occurred in combination with a torn ligament or the like, immobilization can extend for up to 8 weeks. This is followed by a slow rebuilding of the muscles and initially lighter loads. Even after severe sprains, you should, in the best case, still take around 12 weeks of sports break. After the end of these 3 months, however, exercise and full stress are usually possible again.

Read more on the topic: Duration of a sprain

Sprain or Bruise- What's the Difference?

Both the sprain and the bruise are common injuries. In addition, both are often sports injuries. Then what exactly is the difference between a bruise and a sprain?
A bruise, lat. Contusio, is usually caused by an external impact and usually affects the muscles. A sprain, Latin distorsio, on the other hand, arises from twisting or overstretching of mostly joints. The mechanism of the accident is therefore essential for differentiation, less the result of the injury. The symptoms with which both injuries express themselves are almost identical.
Both are classically associated with pain, bruising, swelling and functional restrictions. Unfortunately, presumably precisely for this reason, both terms are often used interchangeably and mixed up. It is therefore not uncommon for a violent blow to the upper arm muscles (for example from a flying ball or similar) to be called a "sprain". Don't let that confuse you.


Sprains are very common, especially due to external violence Sports, and arise from overstretching certain joint structures.
The result is the typical symptoms of swelling, pain and bruises. If the sprain is not related to other injuries like actual ones Torn ligaments or broken bones, it is relatively harmless. As a rule, it heals on its own after a few days to weeks. In order to accelerate the healing process, the person affected should ensure that he moves the upset joint as little as possible, regularly cools and elevates it and gradually approaches his full range of motion again without rushing anything.