Sprain vs. Strain: Is there a major difference?

2015-01-21 10:39:42 by Dr. Joe Congeni - Director of Sports Medicine, as posted on the inside.akronchildrens.org blog.

Football player getting his ankle taped after an injury. (Wikipedia/Creative Commons) Football player getting his ankle taped after an injury. (Wikipedia/Creative Commons)

We recently saw Green Bay Packers quarterback Aaron Rodgers play through a calf strain, while Denver Broncos' Julius Thomas is out for 6 weeks with an ankle sprain. What gives?

Believe it or not, there are major differences between a sprain and a strain. Both injuries have varying degrees, from grade 1 to the most severe, grade 3, but a strain includes the muscle and tendon, whereas a sprain involves the ligament.

Last week, I had the chance to visit in studio WAKR morning show host Ray Horner to discuss these injuries. We also talked about the specifics of high ankle sprains and how they differ from a typical ankle sprain.

Below is an audio file and transcript of our discussion. Originally aired on 1590 WAKR-AM on Jan. 14, 2015.

HORNER: Dr. Joe Congeni with us in studio. Joe ... from the media standpoint and fan standpoint, when we hear, "tear," "broken," we know that our athletes that we cheer for, follow, are on our team are gonna be out for a while. Take that from high school, college to the pro.

When we hear the words, "sprain and strain," we tend to think as fans that okay, that's a week, maybe 2. A strain and a sprain isn't that bad.

Talk about a sprain and a strain because, correct me if I'm wrong, but Aaron Rodgers (quarterback for the Green Bay Packers) has a calf strain, not a tear. That Julius Thomas for the Denver Broncos had an ankle sprain, but we saw he was out 6 weeks. Talk about those 2 areas and how they could linger.

Dr. Joe Congeni Dr. Joe Congeni

DR. CONGENI: Yeah ... I chuckle a little bit at that terminology issue because, honestly, those are different varying degrees of strain and sprain. In its simplest form, grade 1, 2 and 3.


  • Grade 1 is a pulled muscle; muscle tendon unit is overstretched or pulled.

  • A grade 2 is a partial tear, and partial tears can go from just a few fibers to a pretty significant tear, which I think Aaron Rodgers is playing with.

  • Grade 3 is a complete tear. And so, with total inability to push off and play with grade 3 tears, it's harder.


Sprain is the same thing. Now ... strain is muscle and tendon, sprain is ligament.



  • Grade 1: stretch of the ligament. Ligament in the ankle; ankle sprain. Ligament in the knee; MCL or ACL.

  • Grade 2: partial tear.

  • Grade 3: complete tear.


So, it's just variations of the words strain and sprain, but you're right. Typically when we use the term strain, we're meaning a grade 1 or a grade 2.

Even people said a pulled calf for a while, a pulled quad, you know, a quad pull for, uh, Manning (quarterback for the Denver Broncos), but after the season they said, no, that was into the range of where it was actually torn, a grade 2 to grade 3.

HORNER: So when you see Aaron Rodgers, when we see calf strain, most people are saying man, this guy's been limping around for half a season now, but him playing on it doesn't help, for one thing.


HORNER: But obviously, this is a, what did you say, grade 3 or whatever?

DR. CONGENI: A grade 3. A grade 3 is a tear, or a significant grade 2 is where most of the muscle and tendon is torn. It's just ... terminology and the perception is that it's just a pull, the grade 1.

The vast majority in sports is gonna be grade 1s, lesser to be more significant grade 2s and less common of all is the grade 3, the complete tear.

HORNER: We also hear high ankle sprain -- and you and I have talked about that for a long time, so I'm understanding what it is -- the average person, though, out there hears ankle sprain, , ah, I've recovered that in 3, 4 days, a week at most.

DR. CONGENI: Sure. Sure.

HORNER: We see some of these athletes missing half a season, if not the rest of the season, with a high ankle sprain. Talk about the differences.

DR. CONGENI: And, you can almost bet in a sprain that's taking a long time to quiet down in an NFL player like Thomas of the, uh, Denver Broncos, that that was a high sprain.

So, the high sprain is above the 2 bumps on either side of the ankle. You know that a typical low sprain, when you roll the ankle or invert the ankle, most of the swelling and thickening is below those 2 bumps, and so that's a typical sprain.

The two can go together. You can get both at the same time: tear of the ligaments below and tear of the high sprain.


DR. CONGENI: But, the high sprain is between the 2 lower leg bones. Everybody knows the tibia is a big, strong bone; fibula is a smaller bone. There's a really thick ligament there has a lot of blood vessels in it, has a lot of nerve endings in it. It's more of a twisting or a rotational mechanism.


DR. CONGENI: The mechanism's a lot more like an ACL, and when you tear that ligament, it's so thick and strong and has so many nerve endings, very painful, bleeds a lot and swells a lot and the 2 bones actually separate apart. There are times we even have to operate on those high sprains.

So, high sprains at least twice as much . You are exactly accurate. We tell coaches be ready for 3, 4, 5 weeks, rather than the typical ankle sprain being 7, 10 days with some good, aggressive physical therapy.

HORNER: (Quarterback) J.T. Barrett, I wanna go to Ohio State here, broken bone in what, the foot, right?

DR. CONGENI: I thought it was the ankle, but ...

HORNER: The ankle? Okay. ... Often we see some of these players with these bones that are broken in the foot or the ankle, they kind of linger on for a year, a couple years and sometimes these guys just can't recover from this stuff.

DR. CONGENI: You know those are ...

HORNER: Talk to Ohio State fans, can he come back from this?

DR. CONGENI: Yeah, yeah. Ohio State fans are going to have a ball trying to pick out 3 quarterbacks.


DR. CONGENI: Uh, I mean they're going to go to the candy store and have every choice be right because this kid looked fantastic. And anybody that doesn't understand that run Ohio State started with had a lot to do with J.T. Barrett, they weren't paying attention.


DR. CONGENI: That kid was fantastic. And, uh, yes. When people tell you that actually fractures sometimes heal better than really bad sprains, they're right. I see some of the high sprain people kinda walk with a limp, never get that full push-off and explosion. You know, sports nowadays are all about explosion and athleticism.


DR. CONGENI: People that say it was just power, look at how athletic that Ohio State team was: athletic and quick and strong and physical.

Um, the fact is if you lose some of that explosion, that's a big deal, and you might lose that more with a bad high sprain. But, in a lot of those fractures, the bones heal very well. It just takes a little bit longer.

So, he's gonna be out a few months. There was no doubt he wasn't gonna be back for the play-off run, but I think by even spring practice he'll probably be involved and he'll be very ready, certainly, by fall camp next year.

Another fracture that you had mentioned, the same kinda thing, is Alex Mack (center for the Browns). That took the air out of the sails of the Browns for sure, so Browns fans are worrying about that. That was gonna be a few months.

Actually, because you asked about a high sprain, very often when those ligaments tear between the tibia and fibula, with continued stress on that bone, a lot of times the bone fractures and it'll be both together: They'll have torn ligament and broken bone.

If you remember the week after Alex Mack , they were saying they weren't gonna put him on IR (injured reserve) yet because they were gonna see was ligament involved or was it all bone, do you remember that?

HORNER: Right. Yeah.

DR. CONGENI: When they got in there, they saw, when they were fixing the fracture, that he also had ligament damage and he was done for the year.


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