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Sprain vs. Strain in the Bodybuilder

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If you pull something when lifting, it may well be a sprain or strain. Here are their common causes, how they differ and how to treat one.

By Guillermo Escalante, DSc, MBA, ATC, CSCS

Let’s say you’re lifting a fairly challenging weight, and to get past your sticking point you put a little extra oomph into it. Uh-oh, that didn’t feel good, and now you can’t continue your workout. Maybe it’s a sprain, or is it a strain? What’s the difference, anyway?

Although these terms are often used interchangeably, they have very different meanings. By definition, a sprain can range from a partial tear to a complete tear of one or more ligaments. Conversely, a strain is defined as a partial or complete tear of a tendon and/or muscle. Ligaments are stiff and rigid compared to tendons and muscles because they connect one bone to another to help provide joint stability. Muscles and tendons, on the other hand, are softer and more flexible, and tendons specifically attach a muscle to a bone.

Sprains, then, always occur at the joints. Commonly sprained joints include the ankle, knee, shoulder and wrist. While ankle sprains are typical in most sports, shoulder sprains are more common among bodybuilders. Weightlifters often injure the acromioclavicular joint in the shoulder girdle because of the large demands placed on this joint from heavy pressing movements. Knees may become sprained during squats, especially if you don’t maintain proper lower-extremity alignment. Bouncing out of the bottom of a squat or twisting at the knees can put undue stress on the ligaments and lead to a sprain. And as you’ve probably experienced at some point, a sprain causes a loss of stability.

In contrast, strains always occur at the muscle belly or the tendon. Commonly strained bodyparts among lifters include the hamstrings, pectoralis major, patellar tendon, Achilles tendon, rotator cuff and biceps long head tendon.

Both types of injury are often classified as a first-, second- or third-degree sprain or strain. “Rating Your Sprain or Strain” (see below) discusses the differences.

First- and second-degree sprains or strains usually cause a definitive loss of range of motion and pain to the injured site; conversely, third-degree sprains or strains generally cause less pain and a greater loss of range of motion. Bodybuilders who abuse anabolic substances often find that while their muscles can handle the extra weight they lift, their tendons cannot. It’s essential to build a progressive tolerance to increased loads if you want to avoid a tendon rupture.

Although the injuries themselves are quite different, the treatment of a sprain or strain is very similar. Rest, ice, compression and elevation (RICE) are often the first line of defense to help heal the injury. Once the acute inflammatory response has leveled off — usually after 2–7 days — a course of non-steroidal anti-inflammatory drugs may be indicated. Aggressive treatment of sprains or strains typically consists of physical therapy with an emphasis on restoring full range of motion and strength. Flexibility exercises that target the injured area may help expedite the healing process.

Rating Your Sprain or Strain

First Degree

Defined as a partial tear of some fibers (muscle and tendon fibers for strains, ligament fibers for sprains). About one-third of the fibers remain intact.

Second Degree

Defined as a larger partial tear of the fibers (muscle and tendon fibers for strains, ligament fibers for sprains). More than one-third to nearly all of the fibers are torn.

Third Degree

Defined as a full-thickness tear of the fibers (muscle and tendon fibers for strains, ligament fibers for sprains). No fibers remain connected and this injury usually requires surgical intervention.

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