Muscle Strain vs. Ligament Sprain: The First 72 Hours

You land awkwardly or feel a sudden twinge while sprinting. Is it a strain or a sprain, and what should you do now?

The difference

• A strain is an injury to a muscle or tendon. Common sites: hamstring, calf, groin, lower back.
• A sprain is an injury to a ligament, the tough bands connecting bone to bone at a joint. Common sites: ankle, knee, wrist, thumb.

Typical signs

Muscle strain:

• Sudden sharp pain during running, kicking or lifting
• Pain when stretching or contracting the muscle
• Sometimes bruising a day or two later

Ligament sprain:

• Twisting or rolling injury
• Pain and swelling around a joint
• Feeling of looseness or the joint giving way in more serious sprains

The first 72 hours

The current approach, sometimes summarised as PEACE and LOVE, has moved away from just "rest and ice".

Early days (PEACE):

• Protect: reduce activity that hurts for 1 to 3 days, but avoid total rest
• Elevate: raise the limb above heart level when you can
• Avoid anti-inflammatory medicines in the first days unless your doctor advises them, as inflammation is part of healing (pain relief such as paracetamol is generally fine; check with your doctor or pharmacist)
• Compress: a bandage or compression sleeve helps limit swelling
• Educate: understand that most of these injuries improve with active recovery

Ice can help with pain in the short term. Use it wrapped in a cloth for 10 to 15 minutes at a time.

After the first few days (LOVE):

• Load: start gentle movement and weight-bearing as pain allows
• Optimism: confidence and positive expectations aid recovery
• Vascularisation: pain-free cardio (cycling, walking) improves blood flow
• Exercise: restore movement, strength and balance

When to get it checked

See a doctor or go to hospital if you can't put weight on the limb, there's obvious deformity, you heard a loud pop with immediate swelling, there's numbness or the limb is cold, or there's bony tenderness. These can mean a fracture or serious tear.

Also see a physiotherapist if the injury isn't improving after a week, or if it's an injury you've had before.

Common mistakes

• Total rest for weeks, which leads to stiffness and weakness
• Stretching a strained muscle hard in the first days
• Returning to sport as soon as walking feels fine

Find out more about ankle sprains in our pain guide.