Materiały źródłowe

• #1 Sprains – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sprains/symptoms-causes/syc-20377938

  A sprain is a stretching or tearing of ligaments the tough bands of fibrous tissue that connect two bones together in your joints. […] The difference between a sprain and a strain is that a sprain injures the bands of tissue that connect two bones together, while a strain involves an injury to a muscle or to the band of tissue that attaches a muscle to a bone. […] A sprain occurs when you overextend or tear a ligament while severely stressing a joint.

• #2 Sprains and Strains Causes, Symptoms, and Treatments

  https://www.upmc.com/services/orthopaedics/conditions/sprains-strains

  Doctors define a sprain as a condition where one or more of the ligaments in your joint are damaged or torn. Ligaments connect the bones to your joints. When damaged, your joint may become unstable, and you also may experience pain and inflammation. […] A strain is a condition where you stretch or tear a muscle or tendon that connects to the bones in your joint. These muscles and tendons play a crucial role in allowing you to move your body and control movement. When damaged, you may have limitations in mobility and rotation and experience pain. […] Sprains often happen when you twist, turn, or stretch a joint beyond its normal range of motion. This can occur during activities like running, jumping, or playing sports, where you might land awkwardly or change direction suddenly. […] Strains often happen when a muscle or tendon gets stretched too far or contracts too strongly. This can occur during activities that require repetitive movements, lifting heavy objects, or sudden movements.

• #3 Strains | Sprains | MedlinePlus

  https://medlineplus.gov/sprainsandstrains.html

  A sprain is a stretched or torn ligament. Ligaments are tissues that connect bones at a joint. Falling, twisting, or getting hit can all cause a sprain. Ankle and wrist sprains are common. Symptoms include pain, swelling, bruising, and being unable to move your joint. You might feel a pop or tear when the injury happens. […] A strain is a stretched or torn muscle or tendon. Tendons are tissues that connect muscle to bone. Twisting or pulling these tissues can cause a strain. Strains can happen suddenly or develop over time. Back and hamstring muscle strains are common. Many people get strains playing sports. Symptoms include pain, muscle spasms, swelling, and trouble moving the muscle. […] At first, treatment of both sprains and strains usually involves resting the injured area, icing it, wearing a bandage or device that compresses the area, and medicines. Later treatment might include exercise and physical therapy.

• #4 Sprain – Wikipedia

  https://en.wikipedia.org/wiki/Sprain

  A sprain is a soft tissue injury of the ligaments within a joint, often caused by a sudden movement abruptly forcing the joint to exceed its functional range of motion. Ligaments are tough, inelastic fibers made of collagen that connect two or more bones to form a joint and are important for joint stability and proprioception, which is the body’s sense of limb position and movement. […] Acute sprains typically occur when the joint is abruptly forced beyond its functional range of motion, often in the setting of trauma or sports injuries. The most common cause of sprains in general is repetitive movements (overuse). […] Ligaments are collagen fibers that connect bones together, providing passive stabilization to a joint. These fibers can be found in various organizational patterns (parallel, oblique, spiral, etc.) depending on the function of the joint involved. Ligaments can be extra-capsular (located outside the joint capsule), capsular (continuation of the joint capsule), or intra-articular (located within a joint capsule). The location has important implications for healing as blood flow to intra-articular ligaments is diminished compared to extra-capsular or capsular ligaments.

• #5 Sprain – Wikipedia

  https://en.wikipedia.org/wiki/Sprain

  A sprain is a soft tissue injury of the ligaments within a joint, often caused by a sudden movement abruptly forcing the joint to exceed its functional range of motion. Ligaments are tough, inelastic fibers made of collagen that connect two or more bones to form a joint and are important for joint stability and proprioception, which is the body’s sense of limb position and movement. […] Acute sprains typically occur when the joint is abruptly forced beyond its functional range of motion, often in the setting of trauma or sports injuries. The most common cause of sprains in general is repetitive movements (overuse). […] Ligaments are collagen fibers that connect bones together, providing passive stabilization to a joint. These fibers can be found in various organizational patterns (parallel, oblique, spiral, etc.) depending on the function of the joint involved. Ligaments can be extra-capsular (located outside the joint capsule), capsular (continuation of the joint capsule), or intra-articular (located within a joint capsule). The location has important implications for healing as blood flow to intra-articular ligaments is diminished compared to extra-capsular or capsular ligaments.

• #6 Sprain – Wikipedia

  https://en.wikipedia.org/wiki/Sprain

  Collagen fibers have about a 4% elastic zone where fibers stretch out with increased load on the joint. However, exceeding this elastic limit causes a rupture of fibers, leading to a sprain. It is important to recognize that ligaments adapt to training by increasing the cross-sectional area of fibers. When a ligament is immobilized, the ligament has been shown to rapidly weaken. Normal daily activity is important for maintaining about 80-90% of the mechanical properties of a ligament.

• #7 Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability

  https://pmc.ncbi.nlm.nih.gov/articles/PMC164367/

  Objective: To describe the functional anatomy of the ankle complex as it relates to lateral ankle instability and to describe the pathomechanics and pathophysiology of acute lateral ankle sprains and chronic ankle instability. […] Lateral ankle sprains typically occur when the rearfoot undergoes excessive supination on an externally rotated lower leg. Recurrent ankle sprain is extremely common; in fact, the most common predisposition to suffering a sprain is the history of having suffered a previous ankle sprain. Chronic ankle instability may be due to mechanical instability, functional instability, or most likely, a combination of these 2 phenomena. Mechanical instability may be due to specific insufficiencies such as pathologic laxity, arthrokinematic changes, synovial irritation, or degenerative changes. Functional instability is caused by insufficiencies in proprioception and neuromuscular control.

• #8 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content?contenttypeid=90&contentid=P01653

  Sprains and strains are types of injuries. A sprain is an injury to a ligament while a strain is an injury to a muscle or tendon. […] A sudden stretching, twisting, or tearing of a ligament causes a sprain. This injury can happen when a child falls or suffers a hit to the body. […] A pulling or tearing of a muscle or a tendon causes a strain. This type of injury can happen suddenly, such as when a child overstretches a muscle. Or it can happen over time if a child overuses a muscle or tendon. […] Sprains and strains are uncommon in younger children, and fractures or injuries to the growth plate should always be suspected. […] A sudden stretching, twisting, or tearing of a ligament causes a sprain. It can happen from a fall or a hit to the body. […] A pulling or tearing of a muscle or a tendon causes a strain. It can happen suddenly or over time. […] Pain and swelling are some of the most common symptoms of both injuries. […] A physical exam and certain tests, such as X-rays, can help diagnose sprains and strains. […] Treatment may include RICE, pain medicine, and physical therapy. In some cases, surgery may be needed.

• #9 Ankle sprain: pathophysiology, predisposing factors, and management strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3781861/

  LAS result in damage to the passive ligamentous structures of the ankle. Indeed, forceful ankle plantar flexion and inversion, the most common mechanism of injury, often leads to tearing of the lateral ligaments of the ankle. Specifically, the anterior talofibular ligament (ATFL), reported to be the weakest is first ligament injured. Rupture to the ATFL is followed by damage to the calcaneofibular ligament (CFL) and finally to the posterior talofibular ligament (PTFL). Isolated injury to the ATFL occurs in 66% of LAS while ATFL and CFL ruptures occur concurrently in another 20%. The PTFL is not commonly injured because of the large amount of force required to cause damage, as well as the amount of dorsiflexion needed to strain the ligament. The amount of dorsiflexion necessary to strain the PTFL places the ankle in a closed packed and thus more stable position which decreases the likelihood of injury to the ligament. In addition to the lateral ligamentous structures of the talocrural joint, the subtalar ligaments can also be injured.

• #10

  https://link.springer.com/article/10.1007/s40141-013-0041-y

  Lateral ankle sprains have traditionally been described as an excessive inversion and plantar flexion mechanism that results in damage to the lateral ankle ligaments. Current analysis techniques, including those of real time injury mechanisms, and findings in laboratory studies, have shown the mechanism to be inversion and internal rotation of the foot. These findings indicate inversion velocities of up to 1,752 degrees/second and maximum inversion angles of up to 142. The injury is defined by damage to the lateral ankle ligaments. Due to the multi-planar nature of the injury, inversion and internal rotation, damage to the lateral musculature and connective tissue of the lower leg and foot may also occur. Freeman originally assessed recurring instability of the ankle in patients following a lateral ankle sprain. This instability was identified despite no findings of clinical or radiological abnormalities in joint laxity. Freemans hypothesis was that, secondary to ankle ligament injury, proprioceptive deficits affected the muscles of the lower leg and led to deficits in function and continued giving way of the ankle in these patients.

• #11 Musculoskeletal sprains and strains – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/578

  Muscle injuries occur from either direct or indirect trauma. […] Predisposing factors include type of muscle architecture (i.e., pennate muscle, type II fast twitch muscle fibers, muscle-tendon units that span 2 joints), previous injury, and inadequate warm-up before exercise. […] Eccentric contraction (i.e., muscle contraction associated with forcible lengthening of the contracting muscle, such as when lowering a weight or pitching a ball) causes more frequent injury. […] In strains, an excessive tensile force subjected onto the muscle leads to the overstraining of the myofibers and consequently to a rupture near the musculotendinous junction. […] Muscle strain usually occurs in eccentric exercise. […] In eccentric exercise the contracting muscle is forcibly lengthened; in concentric exercise it shortens.

• #12 Muscle Strains: Pathophysiology and New Classification Models | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-662-46491-5_42

  Muscle strains occur most often at the musculotendinous junction as a consequence of an indirect trauma. Very common in sprinters and jumpers, they usually arise from an indirect trauma, from application of excessive tensile forces. Two-joint muscles, muscles contracting eccentrically and with a higher percentage of type II fibers, are most predisposed to be injured. However, the coordination and balance between agonist and antagonist muscles, a previous injury, inadequate rehabilitation, and warm up have to be considered as predisposing them. Since structural and biochemical changes occur after the initial insult, the overall goal is to assist the body with its natural healing process, respecting the inflammatory, repair, and remodeling phases. […] In an attempt to better define acute muscle strain injuries, we describe an imaging (magnetic resonance or ultrasound) nomenclature, which considers the anatomical site, pattern, and severity of the lesion in the acute stage. This system must be assessed with multiple joints to determine its utility, and additional studies are needed prior to its general acceptance.

• #13 Musculoskeletal sprains and strains – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/578

  Muscle injuries occur from either direct or indirect trauma. […] Predisposing factors include type of muscle architecture (i.e., pennate muscle, type II fast twitch muscle fibres, muscle-tendon units that span 2 joints), previous injury, and inadequate warm-up before exercise. […] Eccentric contraction (i.e., muscle contraction associated with forcible lengthening of the contracting muscle, such as when lowering a weight or pitching a ball) causes more frequent injury. […] In strains, an excessive tensile force subjected onto the muscle leads to the overstraining of the myofibres and consequently to a rupture near the musculotendinous junction. […] Muscle strain usually occurs in eccentric exercise. […] In eccentric exercise the contracting muscle is forcibly lengthened; in concentric exercise it shortens.

• #14 The mechanism of hamstring injuries – a systematic review | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-020-03658-8

  A stretch-type injury to the hamstrings is caused by extensive hip flexion with an extended knee. […] Hamstring injuries during sprinting are most likely to occur due to excessive muscle strain caused by eccentric contraction during the late swing phase of the running gait cycle. […] All three studies reported that hamstring injuries occurred due to extensive hip flexion with a hyperextended knee. […] The majority of studies of hamstring injuries during running reported that the hamstrings are most prone to injury during the late swing phase as a result of eccentric loading. […] It was proposed that the late or terminal swing phase placed the hamstring muscles at the highest risk of injury. […] One study concluded that the risk of hamstring injury is greatest during the early stance phase, while five studies reported that injury occurred during the swing phase.

• #15 Sprains and Strains Causes, Symptoms, and Treatments

  https://www.upmc.com/services/orthopaedics/conditions/sprains-strains

  A sprain or a strain may happen from: Starting an intense exercise program too quickly. […] Although sprains and strains are common in athletes, they can happen to anyone who overuses or puts too much stress on their joints and muscles. […] Many factors may put you at risk for a sprain or strain, including: Previous injury. If you previously had a sprain or strain, you’re more susceptible to future injuries in the same area. […] Sprains and strains can lead to complications if not treated or if they’re severe. […] Some common complications include: Chronic pain. If a sprain or strain doesn’t heal properly or if there’s underlying damage, it can lead to long-term or chronic pain in the affected area. […] Joint instability. Severe sprains can cause instability in the affected joint, making it more prone to future injuries or dislocations.

• #16 Sprains and strains | healthdirect

  https://www.healthdirect.gov.au/sprains-and-strains

  Sometimes an ultrasound might be used to see the damaged area more clearly. X-rays can be used to rule out fractures. […] Quick treatment can help decrease the swelling and pain when an injury happens. This treatment is also known as RICE. […] Sprains and strains can take time to heal. It’s important to get the right treatment to help you recover faster. […] Many injuries happen when you suddenly increase the amount or intensity of your activities.

• #17 Sprains and strains | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/sprains-and-strains

  A sprain is an injury to the ligaments and capsule of a joint in the body. […] A strain is an injury to muscles or tendons. […] Healing depends on various factors including the type of tissue and severity of injury, treatment undertaken, previous injuries, and the age and general health of the person. […] With general use, muscles gently contract to resist overstretching. However, sudden twists or jolts can apply greater force than the tissue can tolerate, resulting in a tear or rupture of the fibres. The damage to these fibres triggers an immune reaction called inflammation. […] Inflammation is a complex cascade of biological processes that results in the classic swelling, redness and tenderness associated with sprains and strains. […] A sprain is an injury that involves tearing of the ligaments or joint capsule or both.

• #18 Muscle Strains: Pathophysiology and New Classification Models | Radiology Key

  https://radiologykey.com/muscle-strains-pathophysiology-and-new-classification-models/

  Muscle strains, very common in sprinters and jumpers, usually arise from an indirect trauma, from application of excessive tensile forces. […] The most vulnerable site for an indirect strain injury is the musculotendinous junction, the weakest link within the muscle tendon unit. […] In eccentric muscle actions, when muscle tension increases suddenly, the damage may occur in the area beneath the epimysium and the site of muscle attachment to the periosteum. […] Hamstring strain muscle injuries, the most widely studied, typically occur in the region of the MTJ, a transition zone organized in a system of highly folded membranes, designed to increase the junctional surface area and dissipate energy. […] In this area, even a minor strain, by inducing an incomplete disruption, evident only at microscopy, may weaken it and predispose to further injury. […] Disruptions in the fibers cause biochemical changes both from direct injury to the fibers and from the inflammatory reaction.

• #19 Back Sprains & Strains Causes, Symptoms & Treatments

  https://spineconnection.org/back-pain-conditions/sprains-and-strains/

  A strain is an injury to a muscle that is overstretched or by having to use too much effort to complete the action of lifting an item that is too heavy. […] A sprain is when a ligament (strong bands that hold bones together) is injured (overstretched or torn), and the diagnosis of cervical sprain occurs when the ligamentous structures connecting the cervical facet joints and vertebrae have been damaged. […] Strains and sprains result in soft tissue damage, small amounts of bleeding into the tissue, inflammation, swelling, bruising, and muscle spasms. […] Once damage or trauma occurs to a muscle, tendon, or ligament, inflammation and swelling lead to pain that is sent via the nerves. […] 90% of people make a full recovery from lumbar muscle sprain or strain.

• #20 Low Back Strain and Sprain – AANS

  https://www.aans.org/patients/conditions-treatments/low-back-strain-and-sprain/

  When the lumbar (lower) spine is strained or sprained, the muscles and tissues become swollen. This inflammation causes pain and may cause muscle spasms. […] Lumbar muscle strain is caused when muscle fibers are abnormally stretched or torn. Lumbar sprain is caused when ligaments (the tough bands of tissue that hold bones together) are torn from their attachments. Both of these can result from a sudden injury or from gradual overuse. Lumbar strain or sprain can be debilitating. […] Sprain and strain is commonly treated with nonsteroidal anti-inflammatory medication, if the pain is mild to moderate.

• #21 Sprains vs. Strains | Mass General Brigham

  https://www.massgeneralbrigham.org/en/about/newsroom/articles/sprains-and-strains

  If you are diagnosed with a sprain or strain, your provider can do some tests to determine how severe it is, Kestner says. Sprains and strains are graded: […] Grade 1: Mild sprains and strains occur when there is stretching or microscopic tears in the tissue. […] Grade 2: Moderate sprains and strains cause a partial tear of the tissue. […] Grade 3: Severe sprains and strains cause a complete tear of the ligament, tendon, or muscle. […] Mild and moderate sprains or strains can usually be treated at home. Kestner recommends treating your injury with an approach that providers often describe with the acronym RICE: […] Sprains and strains require time and rest, Kestner says. […] Severe, grade 3 sprains and strains often take months to heal, and sometimes require surgery. […] If you’ve had a sprain or strain in the past, that can make the joint weaker and more prone to future injuries, Kestner says.

• #22 Overview of Sprains and Other Soft-Tissue Injuries – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/sprains-and-other-soft-tissue-injuries/overview-of-sprains-and-other-soft-tissue-injuries

  Tears in ligaments or muscles may be graded as 1st degree: Minimal (fibers are stretched but intact, or only a few fibers are torn) […] 2nd degree: Partial (some to almost all fibers are torn) […] 3rd degree: Complete (all fibers are torn). […] Tendon tears can be partial or complete. With complete tears, the motion produced by the detached muscle is usually lost. Partial tears can result from a single traumatic event (eg, penetrating trauma) or repeated stress (chronically, causing tendinopathy). Motion is often intact, but partial tears may progress to complete tears, particularly when significant or repetitive force is applied. […] Many partial tears in ligaments, tendons, or muscles heal spontaneously. Complete tears often require surgery to restore anatomy and function. Prognosis and treatment vary greatly depending on the location and severity of the injury.

• #23 Sprains, Strains And Tears | Franciscan Health

  https://www.franciscanhealth.org/community/blog/sprains-strains-tears

  Sprains, strains, and tears: these common injuries can sideline anyone, from weekend warriors to those simply navigating daily life. […] A sprain typically involves an injury to a ligament, the stretchy tissue that connects two bones in a joint. […] A strain generally involves an injury to a muscle or tendons, the tissue that connects muscles to bones. […] A tear refers to a more severe sprain or strain that involves the complete separation of ligaments, muscles, and/or tendons. […] The degree of sprain is measured based on the level of tears or stretching to the ligaments. […] A grade I strain or sprain is an injury related to stretching of a ligament/muscle with no tears to tissues. […] A grade II sprain or strain can involve a partial tear to ligaments/muscles. […] A complete tear, called a grade III sprain or strain, is an injury in which the ligament, muscle, or tendon completely pulls off the bone.

• #24 Sprains and Strains Meaning, Causes, First Aid, Treatment

  https://www.medicinenet.com/sprained_ankle/article.htm

  Usually, the mechanism of injury involves placing the muscle-tendon unit or the ligament under excessive stretching, causing damage to the muscle, tendon, or ligament fibers. […] The grading system for sprain injury is similar to that of strains. Grade 1 sprains occur when fibers of the ligament are stretched but not torn. Grade 2 sprains are injuries where the ligament is partially torn. Grade 3 sprains occur when the ligament is completely torn or ruptured.

• #25 Should You Stretch A Muscle Strain? — Physio Network

  https://www.physio-network.com/blog/stretch-muscle-strain/

  Muscle tears occur when the force applied to the tissue generates greater stress or strain than the tissue can withstand. This damages the myofibrils (muscle fibers) as a result of rapid eccentric (lengthening) contractions, often during acceleration or deceleration movements. […] To stretch a muscle strain would appear to repeat the mechanism of injury and increase the potential to further damage an already weakened area. Therefore, by acknowledging that strains occur through loading muscle fibers beyond their capacity, it allows us to determine that immediately stretching/loading again would likely be disadvantageous. […] Irrespective of classification, all muscle strains go through this process. It is the speed at which this occurs which will change depending on the severity of injury.

• #26 Sprains and Strains: Types and Treatment

  https://patient.info/bones-joints-muscles/sports-injuries/sprains-and-strains

  Usually, the damaged ligament or muscle heals by itself over time. Some scar tissue may be produced where there has been a tearing of tissues. […] Extra treatment may be needed for severe sprains (where the ligaments are badly torn (ruptured) or the joint is unstable). […] In some cases, if ligaments are very badly torn or the joint is too unstable, surgery may be advised. Your doctor will assess if this is necessary (but it is not needed in most cases). […] For severe strains (badly torn muscles or tendons), surgery is used very rarely – usually only if there is a complete tear in which the muscle is completely torn or has become unattached to the bone (for example, a severe hamstring injury).

• #27 Sprains and strains | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/sprains-and-strains

  Injury to these tendons or the muscles themselves is called a strain. […] Most soft tissue injuries take a few weeks to heal, depending on the severity of the sprain or strain, any subsequent injuries or issues such as weakness, stiffness, poor balance or function, and the general health of the person. […] Severe injuries, where the tissue has completely ruptured, may need surgery to put the torn pieces back together. […] Whether you have surgery or a period of immobilisation and physical therapy as the treatment for a grade III injury, medium to long-term functional outcomes is similar for either treatment.

• #28 Overview of Sprains and Other Soft-Tissue Injuries – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/sprains-and-other-soft-tissue-injuries/overview-of-sprains-and-other-soft-tissue-injuries

  Serious complications of sprains, strains, and tendon injuries are unusual but may cause permanent limb dysfunction. […] Acute complications (associated injuries) include the following: Bleeding: Bleeding (eg, bruising, ecchymoses) accompanies all significant soft-tissue injuries. Vascular injuries: Rarely, what appears to be a severe sprain may be a spontaneously reduced dislocation (eg, of the knee), which may be accompanied by a limb-threatening arterial injury. Nerve injuries: Nerves may be injured when stretched or damaged by associated injuries such as fractures or dislocations or by blunt blows or crush injuries. […] Long-term complications include the following: Instability: Various ligament injuries, particularly 3rd-degree sprains, can lead to joint instability. Instability can be disabling and increases the risk of osteoarthritis. Stiffness and impaired range of motion: Stiffness is more likely if a joint needs prolonged immobilization. The knee, elbow, and shoulder are particularly prone to posttraumatic stiffness, especially in older people. Osteoarthritis: Injuries that result in joint instability predispose to repeated joint stresses that can damage joint cartilage and result in osteoarthritis.

• #29 Sprains and Strains Causes, Symptoms, and Treatments

  https://www.upmc.com/services/orthopaedics/conditions/sprains-strains

  Limited mobility. Injuries to muscles, tendons, or ligaments can result in decreased flexibility and range of motion, making it difficult to perform daily activities or play sports. […] Recurring injuries. Without proper rehabilitation and strengthening exercises, the risk of recurring sprains or strains in the same area increases. […] Muscle weakness. Prolonged immobilization or lack of appropriate rehabilitation exercises can lead to muscle weakness in the affected area. […] Arthritis. In some cases, severe or repeated injuries to joints can increase the risk of developing arthritis later in life. […] Nerve damage. Injuries to muscles, tendons, or ligaments may also affect nearby nerves, leading to symptoms such as numbness, tingling, or weakness in the affected area.

• #30 Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability

  https://pmc.ncbi.nlm.nih.gov/articles/PMC164367/

  Lateral ankle sprains are often inadequately treated, resulting in frequent recurrence of ankle sprains. […] Lateral ankle instability refers to the existence of an unstable ankle due to lateral ligamentous damage caused by excessive supination or inversion of the rearfoot. […] Chronic ankle instability (CAI) denotes the occurrence of repetitive bouts of lateral ankle instability, resulting in numerous ankle sprains. […] Mechanical instability of the ankle complex occurs as a result of anatomic changes after initial ankle sprain, which lead to insufficiencies that predispose the ankle to further episodes of instability. These changes include pathologic laxity, impaired arthrokinematics, synovial changes, and the development of degenerative joint disease, which may occur in combination or isolation.

• #31 Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability

  https://pmc.ncbi.nlm.nih.gov/articles/PMC164367/

  Pathologic laxity can result in joint instability when the ankle is put in vulnerable positions during functional activities, resulting in subsequent injury to joint structures. […] Mechanical instability of the talocrural joint is traditionally explained in single planes, although this disregards the normal triplanar movement allowed at this joint. […] Injury to the CFL also causes pathologic laxity of the subtalar and talocrural joints. […] Mechanical instability of the ankle complex may also occur due to insufficiencies caused by synovial hypertrophy and impingement or the development of degenerative joint lesions. […] Injury to the lateral ligaments of the ankle results in adverse changes to the neuromuscular system that provides dynamic support to the ankle. […] The contribution of impaired proprioception, while important, does not fully explain why ankle-ligament injury predisposes athletes to functional ankle instability. […] The individual symptoms of functional ankle instability do not occur in isolation but are likely all components of a complex pathoetiologic paradigm.

• #32

  https://link.springer.com/article/10.1007/s40141-013-0041-y

  CAI has been associated with clinical, functional and subjective disability and includes patients with mechanical laxity of the talocrural joint. Tissue damage to the lateral ankle ligaments may lead to chronic mechanical instability identified through clinical exam. Mechanical ankle laxity is a major predictor of the development of CAI. In a systematic review, Hubbard et al. identified that, based on clinical stress tests to the ankle, healing of the lateral ligaments may start between six weeks and three months after initial sprain; however at up to one year follow-up, residual mechanical laxity occurred in 331 % of patients. This timing of the healing process is often incongruent with the length of time in which patients are immobilized and return to physical activity. Specifically, clinicians often push a fast return to functional activities, knowing that the injured ligaments have not had adequate time to completely heal. Further injury prior to the completion of healing may prevent adequate scar tissue formation and ultimately lead to mechanical insufficiencies in the talocrural and subtalar joints. Alterations in arthrokinematics, joint laxity, and synovial and degenerative changes of the joints have been reported in patients with recurrent ankle sprains and CAI. Common clinician assessment includes the use of ligamentous stress test such as the anterior drawer and talar tilt test. The mechanical laxity may lead to further aberrant motion at the joint, resulting in long term osteoarthritic changes. Seventy-eight percent of cases of ankle osteoarthritis were reportedly associated with a history of recurrent lateral ankle sprains, which is a higher rate compared to other large joints. Depending on the laxity and function of the joint, these individuals may require surgery to restore the joint to a more stable condition, although conservative interventions are typically attempted first. The presence of CAI is not always associated with this laxity, but long term arthrokinematics changes associated with laxity may contribute to greater joint degeneration.

• #33

  https://link.springer.com/article/10.1007/s40141-013-0041-y

  The initial damage to the lateral ankle ligaments alters the function of mechanoreceptors of these ligaments disrupting the ability to sense motion at the joint. The muscles surrounding the joint may also be affected when damage occurs to the mechanoreceptors of the lateral ligaments affecting postural control and muscle function. Alterations in the sensorimotor control also have been associated with kinematic and kinetic changes during gait. Clinical deficits have been identified in dynamic and static balance and subjective function. The importance of sensory input from the structures that surround the ankle is the most commonly accepted reason for the subjective instability, as the subjective instability is present even in those individuals who do not have pronounced mechanical laxity. The multimodal input from mechanoreceptors of the ligaments, muscles, tendons, and skin all play a role in static and dynamic joint stability. The redundancy in sensing force position, joint position, stretch and tension in these sensory systems emphasize the importance of these structures in healthy individuals. Deficits in sensation of vibration, joint position sense, and force sense have all been identified in patients with ankle instability. Healing of the lateral ligaments occurs and may restore mechanical support; however, repair of the neurological structures within this tissue is not thought to occur.

• #34

  https://link.springer.com/article/10.1007/s40141-013-0041-y

  Clinical evaluation of sensory organs would allow clinicians to better identify deficits in this population. The assessment of balance can help to identify balance deficits associated with CAI. Instrumented and non-instrumented balance assessments have been used to study stability during single-limb stance in patients with CAI. Force-plate assessment of balance is considered the gold standard but is not readily used in clinical practice. Deficits in balance, assessed by force-plate center of pressure measures, have consistently been reported following acute ankle sprains but not in subjects with CAI. Time-to-boundary measures, a more sensitive assessment, however, have identified altered postural control strategies in subjects with CAI. Clinical assessment should include both dynamic and static balance. The star excursion balance test (SEBT) and balance error scoring system (BESS) has been shown to identify deficits associated with ankle instability. Balance training has long been used in rehabilitation of patients with CAI. Balance training commonly involves a progression of single limb balance adding perturbations that involve removing visual input, changing surface or adding tasks such as the ball toss or reaching tasks. Dynamic balance can include more challenging tasks such as jumping. The SEBT has been shown to be a reliable test to evaluate dynamic balance but can also be used as a clinical rehabilitation exercise.

• #35 Cervical Sprain and Strain: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/306176-overview

  Cervical strain is produced by an overload injury to the muscle-tendon unit because of excessive forces on the cervical spine. The cause is thought to be the elongation and tearing of muscles or ligaments. Secondary edema, hemorrhage, and inflammation may occur. […] A major advance in the understanding of chronic pain following whiplash injury over the past two decades has been the discovery that central sensitization plays an important role in symptom perpetuation. […] Many cervical muscles do not terminate in tendons but attach directly to the periosteum. Muscles respond to injury by contracting, with surrounding muscles recruited in an attempt to splint the injured muscle. Myofascial pain syndrome, which is thought to be the resultant clinical picture, may be a secondary tissue response to disc or facet-joint injury.

• #36 Cervical Sprain and Strain: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/306176-overview

  Facet capsular ligaments have been shown to contain free (nociceptive) nerve endings, and distending these ligaments by administering facet joint injections has produced whiplash-like pain patterns in healthy individuals. The cervical facet capsular ligaments may be injured under whiplashlike loads of combined shear, bending, and compression forces; this mechanism provides a mechanical basis for injury caused by whiplash loading. […] Chronic pain associated with cervical strains is most likely to affect the zygapophysial (facet) joints, intervertebral discs, and upper cervical ligaments. […] An overload injury to the muscle-tendon unit produces cervical strain because of excessive forces on the cervical spine. This injury is accompanied by elongation and tearing of muscles or ligaments, secondary edema, hemorrhage, and inflammation. Many cervical muscles attach directly to bone (periosteum), and the muscle response to injury is contraction, with surrounding muscles recruited to splint the injured muscle.

• #37 Ankle sprain: pathophysiology, predisposing factors, and management strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3781861/

  With damage to the ligamentous stabilizers of the ankle after a LAS, an associated increase in the motion available between the bones of the ankle/foot complex occurs (hypermobility). The resulting hypermobility can be assessed qualitatively and empirically using various clinical techniques such as manual stress tests, instrumented arthrometry and stress radiographs. In order to regain stability of the ankle joint, immediate care and rehabilitation should focus on enhancing ligament healing. Acutely, this occurs by protecting the joint (immobilization, crutch use) then slowly adding exercises that help the newly laid down collagen align with the forces of the ankle. The current literature suggests it takes over six weeks for ligament healing to occur. However, studies have also documented joint laxity six months after injury. The chronic laxity that has been reported in the literature may be due to inappropriate rehabilitation, which necessitates the need for further investigation into the type of care and treatment that will best facilitate tissue healing, and normal joint function.

• #38 Sprains and Strains of the Neck – Musculoskeletal Conditions

  https://learnmuscles.com/blog/2017/08/08/sprains-strains-neck/

  Therefore, most ligamentous sprains occur when the neck is thrown to the end ranges of motion. Injuries that are primarily muscular strains tend to occur midrange in motion patterns. […] Given that strains and sprains involve torn soft tissue, pain, inflammation, and bruising are usually present when they are in the acute stage. Muscular splinting/spasming is also present in the acute stage and often persists long-term. […] The mechanism for sprains and strains is similar. An excessive pulling force causes a disruption of the fibers of the ligament or musculature. This pulling force can occur during a macrotrauma, such as the whiplash of a car accident. It can also result from repeated postural or movement microtraumas, such as overuse injuries that place excessive tension on ligaments and muscles over time.

• #39 Sprains and Strains of the Neck – Musculoskeletal Conditions

  https://learnmuscles.com/blog/2017/08/08/sprains-strains-neck/

  The function of a ligament is to limit motion of a joint; therefore, if the ligament is torn and stretched, the joint tends to become hypermobile and less stable. This may be masked during the acute phase by muscular splinting/spasming. Strains, on the other hand, tend to result in joint hypomobility, both because of muscular spasming that occurs in the short run and often continues into the long run, as well as the formation of scar tissue adhesions that occur during the healing process. […] Whiplash causes an overstretching and/or tearing of soft tissue. Overstretching triggers the muscle spindle stretch reflex to occur, resulting in spasmed muscles. Consistent with the general use of the terms, if tearing of muscular tissue occurs, it is termed a strain; if ligaments are torn, it is termed a sprain. The sprain component is often the more severe of the two, resulting in a loss of stability of the neck. […] Depending on how the neck is thrown during an automobile accident or other injury, different ligaments can be sprained.

• #40 Sprains & strains | PPT

  https://www.slideshare.net/ParveenKumarChadha/sprains-strains

  Treatment focuses on RICE – rest, ice, compression, and elevation to reduce swelling along with analgesics and immobilization if severe. […] Time needed for full recovery: – Mild sprain/strain: three to six weeks – Moderate sprain/strain: two to three months – Severe sprain/strain: eight to 12 months. […] Although we cannot prevent all sprains and strains from occurring, there are some tips on how to avoid them: – Stretch before you workout with heavy items – Use proper footwear for the activity you are doing.

• #41 Sprains, Strains & Other Soft-Tissue Injuries – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/sprains-strains-and-other-soft-tissue-injuries/

  The most common soft tissues injured are muscles, tendons, and ligaments. These injuries often occur during sports and exercise activities, but sometimes simple everyday activities can cause an injury. […] Sprains, strains, and contusions, as well as tendinitis and bursitis, are common soft-tissue injuries. Even with appropriate treatment, these injuries may require a prolonged amount of time to heal. […] Soft-tissue injuries fall into two basic categories: acute injuries and overuse injuries. […] Acute injuries are caused by a sudden trauma, such as a fall, twist, or blow to the body. Examples include sprains, strains, and contusions. […] Overuse injuries occur gradually over time when an athletic or other activity is repeated so often that areas of the body do not have enough time to heal between occurrences. Tendinitis and bursitis are common soft-tissue overuse injuries.

• #42 Sprains, Strains And Tears | Franciscan Health

  https://www.franciscanhealth.org/community/blog/sprains-strains-tears

  A more severe Grade III sprain marked by severe pain, swelling and bruising, may require a walking boot or ankle brace to stabilize the area during healing and physical therapy to aid the healing process. […] A sprained joint can become susceptible to repeated sprains if steps aren’t taken to treat the initial injury fully. […] There are some relatively easy things that we can do in a clinical setting to reduce the likelihood that a sprain or strain would reoccur. […] The stronger we get all the muscles around it, the more stable that joint’s going to be.

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