Often sprains and strains are placed into a classification system to rate the severity of the injury and are similar.

Sprains are broken down into three grades: grade 1 sprain, grade 2 sprain, and grade 3 sprain.

  • Grade 1 sprains cause pain and swelling and are the result of microscopic tearing of the ligament (1, 2).
    • Some examples of a grade 1 sprain are hyperextension of a joint – whiplash or turf toe and may or may not need physical therapy intervention (1).
  • Grade 2 sprains are a partial tear of the ligament and is visible on imaging (1, 2). Pain and swelling are present and grade 2 sprains generally recover with physical therapy (1,2 ).
  • Grade 3 sprains are ligament ruptures or a complete tear of the ligament (1, 2).
    • In some cases, a grade 3 tear may require a surgery to reconstruct the stability of the joint (1, 2).
    • Instability and lack of trust in a joint to support body weight and movement are key factors on determining what medical pathway to follow.
    • In some case, such as a grade 3, complete rupture of the medial collateral ligament (MCL) of the knee, often times a surgical repair is not performed. Why? Depends on the orthopedic surgeon and patient’s have done exceptionally well without the surgery.

Strains also come in three grades traditionally.

  • Grade 1 (mild) strain refers to stretching or minimal disruption of muscles cells (3).
    • There may be localized pain, contracture (tightening) and hemorrhage (local bleeding/bruising), full range of motion, and the ability to continue activity (3).
  • Grade 2 (moderate) strain is associated with tearing of muscle fibers without a complete rupture (3).
    • Grade 2 strains have moderate and poorly localized pain, loss of range of motion, and cannot continue with activity (3).
  • Grade 3 (severe) strain is a complete muscle rupture (3).
    • Grade 3 strain leads to 50% loss of range of motion, loss of muscle density and size compared to the opposite side, diffuse pain, and significant bruising (3).
  • This system of classification is the most basic used. However, several other classification systems have been developed such as the Munich Muscle Injury Classification; The Italian Society of Muscle, Ligament, and Tendons; the British Athletic Classification; and, the MLG-R Classification (3). What? These system try to further specify the degree of the injury.

 

References

1. Ligament Injuries - AOA Orthopedic Specialists. AOA Orthopedic Specialists. Published May 12, 2020. https://www.arlingtonortho.com/ligament-injuries/

2. Ligament Injuries/Chronic sprain. Boston Sports. Published 2017. https://bostonsportsandbiologics.com/conditions/knee/ligament-injuries

3. Grassi A, Quaglia A, Canata G, Zaffagnini S. An update on the grading of muscle injuries: a narrative review from clinical to comprehensive systems. Joints. 2016;04(01):039-046. doi:https://doi.org/10.11138/jts/2016.4.1.039