GPAtlas🧭 When to suspect
A sprain is a stretch or tear of a ligament (the tissue connecting bone to bone), while a strain is an injury to a muscle or its tendon. Both are common soft-tissue injuries, typically following a sudden twist, overstretch, direct blow, or awkward landing. Sprains are commonest at the ankle, wrist, thumb and knee; strains at the calf, hamstring and lower back. The great majority are minor and settle well with self-care.
The clinical task in primary care is twofold: exclude what is not a simple sprain – a fracture, dislocation, complete tendon rupture, neurovascular injury or compartment syndrome, or a septic joint – and then give clear self-care and rehabilitation advice so the injury heals fully and does not become a chronic problem. Validated decision tools (the Ottawa rules) keep X-ray use proportionate.
Severity is graded I–III, which guides expected recovery and the threshold for referral.
| Grade | Features | Typical course / action |
|---|---|---|
| Grade I (mild) | Overstretch with microscopic tearing; mild pain and swelling, no instability; usually able to weight-bear. | Self-care; recovery over days to ~2 weeks. |
| Grade II (moderate) | Partial tear; moderate pain, swelling and bruising; some instability or functional loss; painful weight-bearing. | Self-care plus analgesia; consider physiotherapy; recovery over weeks. |
| Grade III (severe) | Complete tear or rupture; severe swelling and bruising, marked instability; often unable to weight-bear. | Exclude fracture/rupture and refer; recovery over weeks to months. |
Source: NICE
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