Sprains, Strains and Contusions

Sprains, strains, and contusions are injuries that do not involve bones.  Because they do not involve the bones, they are called “soft tissue” injuries.  Sprains and strains are similar and are often confused.  A contusion is just another word for a bruise.

Sprains are injuries to the ligaments that surround the joints.  The ligaments are strong bands of fibrous tissue.  Ligaments firmly connect one bone to another while still allowing just the right amount of movement.  A ligament can be stretched or torn. The ligaments in the body, which are the most vulnerable to injury, are in the ankles, knees, wrist and back.  Back sprains are probably the most serious.   

Most ligamentous sprains in the extremities heal with rest, ice, compression, elevation, and exercise. Back sprains are treated with a brief period of rest, but early mobilization and more exercise are actually better.  Pain medications, anti-inflammatory medicines and muscle relaxants can be of great help, especially in the short term. 

Strains are injuries to the muscles.  Muscles are the organs that power the body.  Your bones are supported by muscles and tendons. Tendons connect muscles to bones. The areas of your body that are most vulnerable to sprains are your feet, legs and back. A strain may be a simple stretch in your muscle or tendon, or it may be a tear.

The treatment for a strain is similar to a strain.  For the back, early mobilization and exercise are helpful as are some medications.

A contusion is a bruise caused by a blow to your muscle, tendon, or ligament. The bruise is caused when blood pools around the injured area.  It may discolor your skin.

Most contusions are mild and respond well when you rest, apply ice and compression, and elevate the injured area. If symptoms persist, medical care should be sought to prevent permanent damage to the soft tissues.

Some of the other soft-tissue injuries you may experience include:

  • tendonitis (inflammation of the tendons)
  • bursitis (inflammation of the joint spaces)
  • stress injuries (overuse type injuries)


Inflammation is a healing response to injury and is usually accompanied by swelling, heat, redness, and pain. An inflammation in a tendon or in the tendon covering is called tendonitis. What usually causes tendonitis is not just a single injury but a series of small stresses that repeatedly aggravate the tendon.

Professional baseball players, swimmers, tennis players, and golfers are susceptible to tendonitis in their shoulders and arms. Soccer and basketball players, runners and aerobic dancers are prone to tendon inflammation in their legs and feet.

Tendinitis may be treated by rest to eliminate stress, anti-inflammatory medication, steroid injections, splinting, and exercises to correct muscle imbalance and improve flexibility. Persistent inflammation may cause damage to the tendon which may necessitate surgical correction.


A bursa is a sac filled with fluid. It is located between a bone and a tendon or muscle, and it allows the tendon to slide smoothly over the bone.

Repeated small stresses and overuse can cause the bursa in your shoulder, elbow, hip, knee, or ankle to swell. This swelling and irritation is called bursitis, and many people experience it in association with tendonitis.

Bursitis can usually be relieved by rest and possibly with anti-inflammatory medication. Some orthopaedic surgeons also inject the bursa with additional medication to reduce the inflammation.

Stress fractures

When one of your bones is stressed by overuse, tiny breaks in the bone can occur. The injury is termed a stress fracture. Early symptoms may be pain and swelling in the region of the stress fracture. The bones of your lower leg and foot are particularly prone to stress fractures. The fracture may not be seen on initial routine ex-rays, requiring a bone scan to obtain the diagnosis.

These injuries are treated by rest, activity modification, cast immobilization, and rarely by surgery.

Good Care of Stress fractures

If you're an athlete or a fitness enthusiast, you should pay close attention to your body's warning signs. Fatigue and pain are usually a signal that you're pressing too hard. Be sure to stretch thoroughly before your work-out, and stop before you're exhausted.

Stress injuries can also result from poor muscle balance, lack of flexibility, or because of weakness in soft tissues cause by previous injuries. These injuries to the muscle, bone ligaments, and tendons may require a prolonged amount of time to heal in spite of appropriate care.

Consult your doctor for treatment of these soft tissue and bone injuries. Besides treating the problem, he or she can develop a program of exercise or rehabilitation to restore function.

What Complications Might Develop after treatment for Stress fractures?

Complications of severe injuries include fractures, dislocations, and avulsion injuries (tearing away of a part of the ligament). 

What Is The Likely Outcome of Stress fractures treatments?

Most sprains and strains heal on their own without significant functional impairment.  There may be an increased potential for recurrence, particularly in people with more severe injuries or in those who do not allow previous injuries to heal completely.

 What Are The Possible Work Restrictions and Accommodations?

Persons with severe sprains and/or strains, whose jobs require extensive lifting or bending, may require temporary reassignment to more sedentary duties.

What Else Might It Be?

Differential diagnoses include back pain due to numerous other causes, such as a problem with an internal organ, a bone disease, a tumor, a muscle disease, or psychological stress.

Go to the next page on chronic pain.

Go to the next page on trauma.

Go the next chapter on procedures.

The information in this site briefly describes issues related to medical treatments, and has been licensed by from Northern California Neurosurgery Medical Group, Inc., who is solely responsible for said content.  This web site is not a substitute for good medical care or for a consultation with a spine specialist. It should not be used to plan your treatment. The well considered advice of a specialist who has personally examined you is always superior to even the best internet pages.

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Last modified: 07/27/08