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Is that sudden pop in your ankle or jolt of pain in your lower back a sprain or a strain? What about that pain in your wrist, ankle, or shoulder?

You may wonder, how are strains and sprains different from each other? And does the difference matter in a meaningful way?

Yes and no.

The severity of your sprain or strain matters more than the definition.

Understanding the difference between the two is still helpful. Because the more information you have about how your body works, the better you can prevent injuries.

Sprain vs. Strain: What Is the Real Difference?

Sprains and strains are both soft-tissue injuries. Soft tissue is basically everything around a joint that’s not a bone. The difference between a sprain and a strain is which type of soft tissue you injured.

A sprain happens when you hurt a ligament. Ligaments are like stretchy ropes that hold your bones together at a joint.

For example, it’s common to sprain areas full of ligaments, like ankles, wrists, and knees. Athletes often sprain the anterior cruciate ligament (ACL) in their knee.

A strain happens when you hurt a muscle or tendon. Tendons and muscles are a group because of how they work together. Tendons are strong bands of tissue that connect your muscles to your bones.

With a strain, people sometimes say they “pulled a muscle.”

Strains are common in hamstrings (the back of your upper leg) and the lower back. If you have a rotator cuff tendon injury, that’s a type of strain.

Sprains and strains both range from mild to severe, from micro-tears to complete tears. A really severe sprain or really severe strain may require surgery.

At the other end of the spectrum, mild sprains and strains can often heal on their own with rest and home care.

Do Sprains and Strains Feel Differently?

Sprains and strains have many of the same symptoms, like:

• Bruising, which may develop right away or shortly afterward.
• Feeling that you can’t put weight on the area or move it around as you normally would.
• Pain, often sharp.
• Swelling around the injury.

With either a severe sprain or strain, you might feel a pop. People often describe this feeling when tearing a hamstring or severely spraining an ankle.

Muscle strains sometimes also include muscle spasms. For example, with a low back strain, you might have a feeling of muscles “locking up.”

How Do Sprains and Strains Happen?

Trauma is the leading cause of both sprains and strains. Sprains and strains can happen in equal measure when you have trauma from:

• Accidents involving wheels, like bikes and scooters.
• Athletic injuries.
• Car accidents.
• Hits to the body.
• Jumping and landing wrong.
• Lifting heavy things improperly.
• Tripping and falling.

We think of sprains and strains as acute injuries. For example, you’re walking along and misstep off the curb. Your ankle twists violently, and you sprain a ligament.

However, sprains and strains can also happen because of overuse. This is more likely with a muscle or tendon strain.

For example, rotator cuff tendon tears can happen with repetitive motion. Athletes are at risk for overuse injuries to the soft tissue.

Types of Sprains and Strains

Doctors organize both sprains and strains into three types.

• Grade 1 strain or sprain — A mild injury, with some ligament damage or small tears in the muscle fibers. Think of this as the classic “pulled muscle” or sprain that makes movement harder. You mostly need rest and ice, though even small sprains can take a while to heal.
• Grade 2 strain or sprain — You may have a partial tear of the ligament or muscle. Your joint might feel unstable, and you might have a noticeable loss in range of motion. This is when you might need a boot, splint, sling, or other way to immobilize the injury to help it heal.
• Grade 3 strain or sprain — This is the most severe and means you’ve completely torn the ligament or ruptured the tendon. Your muscle may have separated from the tendon. You might need surgery.

Diagnosing Sprains and Strains

Doctors use the same technology to diagnose both sprains and strains.

First, you might have an x-ray. This can rule out a broken bone.

However, x-rays don’t do a very good job of showing soft-tissue injuries. Depending on your symptoms and the physical exam, your doctor might order an MRI.

An MRI, or magnetic resonance imaging scan, shows more detail of soft tissue. It can show tears to ligaments, muscles, and tendons.

Not all sprains or strains need the advanced imaging an MRI provides. A doctor can often diagnose a mild sprain or strain with no imaging at all.

Treating a Ligament Sprain vs. Treating a Muscle or Tendon Strain

The treatments for both are similar. It’s the severity that guides the options, versus the type of soft-tissue injury.

For mild and some moderate sprains and strains, your doctor may suggest taking over-the-counter (OTC) medicine. This includes anti-inflammatory drugs like ibuprofen.

They may also prescribe RICE, which stands for:

• Rest, meaning you should rest the injury, stay off it, and don’t use it.
• Ice to reduce swelling. Ice the injury for 20 minutes on, 20 minutes off, as much as you can for the first 24 to 48 hours.
• Compression, such as tape or an ACE bandage, to help with swelling.
• Elevation means keeping the injury above your heart (if possible) or off the ground.

For a tear or unstable joint, your doctor may give you a boot or a sling. This keeps the joint from moving and helps it heal. You may also need crutches to keep weight off of the injury.

For moderate-to-severe and severe strains and sprains, you may need surgery. For example, ACL tears  and rotator cuff tears often require surgery to repair.

Your doctor may also prescribe physical therapy (PT). PT helps get you stronger after surgery. It’s also a treatment on its own, especially for mild strains and sprains.

PT can help you shore up muscle imbalances or areas of weakness. For example, if you’re prone to ankle sprains, a physical therapist can work with you to help strengthen the ligaments and surrounding areas.

If you suspect you have a sprain or strain and your pain or other symptoms are severe, don’t wait. Make an appointment with your primary care doctor or a sports medicine doctor. Or find a UPMC orthopedic specialist.