Sprains and Strains

This month we will look at a topic that is sure to confront every bowhunter sooner or later. Muscle and ligament injuries can occur from overuse or sudden trauma. These injuries can range from mild to severe and may even require surgery.

First we need to discuss a little anatomy and define our terms. Bones are hooked together by ligaments. Ligaments cross joints and basically function as living rubber bands which allow your joints to bend in their normal range of motion. Ligaments also provide joint stability and prevent the joint from bending in abnormal directions which could cause a joint dislocation or muscular damage. Sprain is the term we use to describe injuries to ligaments. Muscles attach to bone via tendons. Tendons are like ropes which allow the contraction of your muscles to move your bones. Tendons also frequently cross joints but are not a major factor in joint stability. Strain is the medical term for a pulled muscular tendon injury.

Sprains are injuries to your joints. These injuries typically occur when a joint is suddenly moved or forced in an abnormal motion. The classic ligament injury is the ACL ligament rupture in the knee of skiers. When the joint is forced into a sudden unusual position the ligaments or "living rubber bands" are severely stretched. How badly they are damaged defines the degree of injury. A first degree sprain is a minor stretch of the ligament. You will typically have minimal pain and swelling. The integrity of the joint is intact and stability is maintained. These heal well with minimal treatment. A second degree sprain is more serious. The stretch is more severe and there is a partial tear of the ligament. There will be increased pain and swelling and you typically will develop a black and blue(ecchymosis) at the site of the injury. This is from the hemorrhage at the site of the injury. These injuries can lead to permanent joint pain and instability if not treated appropriately. Ligaments have a very limited blood supply and heal very slowly. Improper initial therapy can greatly delay healing or increase the chances of permanent instability. Third degree sprains mean that the ligament has been completely torn. There will often be increased swelling and ecchymosis. The joint will be somewhat unstable depending on the ligament that has ruptured. The ligament can not heal back together without surgery.

Treatment of sprains starts with a trip to see your doctor. As mentioned above these are injuries to your joints and the first step in treatment is to make sure that there are no broken bones. In most cases your doctor will get an x-ray and rule out a fracture. This can be very difficult without an X-ray as the pain and swelling can make the physical exam unreliable. X-rays only show bony injuries and do not really help diagnose sprains, such as this picture to the left of a fractured ankle. The doctor will need to examine your injured joint for swelling, pain, and ecchymosis. If the pain is not too severe the physician will stress your joint to check for instability. This greatly helps to define the sprain and guide therapy. Often at the initial visit the pain and swelling will be too great and the joint can not be adequately stressed. In these cases you will typically be immobilized and rechecked in 3-4 days when the pain and swelling have improved. At this time the joint can be stressed and further therapy outlined.

Initial therapy is the same for all sprains. Rest, ice , compression and elevation (RICE) are the mainstays of therapy. These maneuvers are used to decrease swelling and prevent further injury. Rest is self explanatory. The amount of time to limit activity is related to the severity of the injury. In general activity should be limited as long as the pain is severe. Rehabilitation of an injury always involves some pain as range of motion is restored but intense or severe pain is your body's way of telling you that you are doing too much too soon. In more severe sprains you may be placed in a splint to further limit mobility and aid in healing. Ice should be applied to the injured area 3-4 times per day for 20 minutes at a time. Do this for the first 2 days. Compression can be maintained with an ACE bandage. These will often be put on by your doctor. When you reapply them make sure that you do not stretch the ACE too tightly. This can cut off your blood supply. The wrap should be minimally stretched. If the wrap is too tight you may notice pain, coolness or numbness below the wrap. Loosen it immediately! Elevation should be used as much as possible for the first 48 hours. Try to keep the injured area above your heart as much as you can. These treatments in connection with a visit to your doctor outline the framework for the treatment for sprains. In first or mild second degree sprains this may be all that is needed. More severe injuries will require longer rehabilitation times. Physical therapy and even surgery may be required depending on the ligament injured. Even though all third degree sprains mean the ligament is ruptured, not all require surgery. Even severe ankle sprains do well with conservative therapy whereas third degree knee sprains are typically operatively repaired. It also depends on the patient. Ligamentous shoulder injuries are a problem for bowhunters. We may elect to have these repaired even though most "normal" people would not need the repair for everyday living. In these cases it is worth the effort to see a orthopedic surgeon who specializes in sports medicine. They have the experience and training with athletes that is necessary to get you back shooting. While your orthopedist may not have much experience with archery he or she will have a very thorough understanding of shoulder biomechanics and what needs to be repaired and what can be rehabilitated.

Strains are injuries to muscles and tendons. Muscles are attached to bones via tendons. Tendons function as ropes which allow contraction of the muscle to move the bone. Strains result from violent contraction of the muscle or from stretching the muscle beyond it's normal elasticity. This can cause damage to the tendon or the muscle itself. Strains are graded very similar to the system used above for sprains. First degree sprains are a mild injury to the tendon and or muscle. You will usually notice pain , swelling and muscular spasm. While it may be painful, muscular strength is usually preserved. Second degree strains are the next stage and involve further tearing of muscular fibers and tendon fibers. There will be a loss of muscular strength and a black and blue where the muscle bled. Third degree strain is a complete tear of the muscle or tendon such that the muscle is no longer properly attached to the bone. There will be a complete loss of function. Strains are initially treated just like sprains. A trip to your doctor to grade the strain and make sure there is no fracture is always worth it. Rest, ice ,compression and elevation are the initial treatment. For mild strains, gentle stretching exercises can help limit muscular spasm. Second degree strains will typically require longer periods of immobilization and some physical therapy. Third degree strains need to be seen by an Orthopedic surgeon for possible reattachment. Because muscles have a much better blood supply, strains usually heal faster and more completely. Your muscles are quite adaptable and strength training and stretching exercises can completely rehabilitate most first and second degree muscle pulls. In some cases even complete ruptures do not need surgery and you can rehab around the deficit. An Orthopedic Surgeon who specializes in sports can once again be very helpful in these situations.

While sprains and strains are a somewhat inevitable part of hard hunting there are things that you can do to prevent them or at least minimize your injury. A long term weight training program will increase the strength of your tendons and muscles and provide increased stability around your joints. Even light weights can have a very beneficial effect if used consistently. Stretching your muscles also will prevent many muscle strains. The key to stretching is to make it a part of your everyday activities. Increased flexibility will prevent many injuries as well as make many hunting activities such as hanging a treestand easier. For weight training and stretching to be successful they need to be done year round. Starting a week before hunting season will only make your sore. You will probably get discouraged and give up. A simple preventative program as well as appropriate treatment when an injury does occur can minimize your down time. This will get you back to your activities in the shortest amount of time and with minimal long term problems.