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.
First, exclude what is not a simple sprain – a fracture, dislocation, complete tendon rupture, neurovascular injury or compartment syndrome, or a septic joint.
• Validated decision tools (the Ottawa rules) keep X-ray use proportionate.
Then give clear self-care and rehabilitation advice so the injury heals fully and does not become a chronic problem.
Severity is graded I–III, which guides expected recovery and the threshold for referral.
| Grade | Features | Typical course and 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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