Acute Injury Management – Sprain vs Strain vs Contusion


In working in any sport, ligament and muscle injuries are common, but especially so in contact sports such as hockey, football, and rugby. Having worked in rugby, I have seen my fair share of acute sprains, strains and contusions. It is important that each injury be handled appropriately, especially in the acute phase as this can influence the healing timeline.   

What is the difference between a sprain, a strain, and a contusion?

Firstly, ligaments are SPRAINED and muscles are STRAINED. Ligaments add to the stability of a joint and injuries to these occur when they are stressed under high loads. Ligament sprains can be classified into one of 3 categories:

Grade I: Ligament fibers are stretched, but there is no laxity (excess movement) when stressing the tissue

Grade II: Ligament fibers are stretched further and there is some tearing in the ligament ranging from a few fibers to almost the full thickness of the ligament. Importantly, there is still a definite end point when the ligament is stressed.

Grade III: The ligament is completely torn and the joint will have excess movement as the stability provided by the ligament will no longer be present. On testing, there will not be a definite end point.

Acute management of ligament injuries involve standard first aid practices such as protecting the area, including offloading if necessary, ice, elevate, and compressing so as to limit the amount of swelling in the joint. After the acute phase which can last from 2-5 days, it is important to begin to build up strength and stability in the joint and eventually return to functional training and sport.  

Injury to muscle is one of the most common injuries in sport whether it is a muscle strain/tear or a contusion. Muscle strains occur when there is excess load placed on the tissue and it is not able to tolerate the demands – these commonly occur on either acceleration or deceleration. 2-joint muscles are the most commonly affected – for example, the quadriceps that cross both the hip and the knee. Other commonly strained muscles include the hamstrings and gastrocnemius (calf muscle).

Similar to ligament sprains, muscle strains can be classified into three categories:

Grade I: a small number of muscle fibers are torn. There will be pain at the site of the strain, but muscle strength will be relatively the same side to side.

Grade II: a larger number of fibers are torn and can range from a moderate amount of tissue to close to a full tear in the muscle. There is typically localized pain and swelling in the muscle. Strength and range of motion are limited.

Grade III: This is a complete tear of the muscle. There will be significant weakness and depending on the injury, the individual may or may not experience pain.

Acute management of this injury involves ice and compression immediately to reduce swelling. Immobilization may be implemented for the first 24-48 hours depending on the injury. Avoid excessive stretching as well as massage for the first 24-48 hours. Gentle mobilization may be implemented, but only within pain limits (don’t push through pain).


Lastly, muscle contusions typically occur due to a direct blow to the area such as a collision with another player or contact with equipment. There is localized damage to the muscle and bleeding in the muscle associated with it. The front of the thigh (quadriceps) is the most common area to sustain a contusion injury.

Appropriate acute management of a contusion injury is imperative. To minimize bleeding, compression and ice should be applied as soon as possible and the area of injury should be kept on stretch to prevent significant losses in motion. The use of heat and massage should be avoided in the acute phase as these techniques increase blood flow to the area which is not desirable as there is already such a large increase in blood flow to the area due to injury.

Managing injuries appropriately in the early stages can help with improving outcomes throughout the rehabilitation process. When resuming activities, remember to stay within pain limits. It is important to remember that each injury is unique and a physiotherapist can help guide you through an appropriate rehabilitation program specific to your injury. 

Gurmeet Dhillon – MScPT

Registered Physiotherapist, Sport Physiotherapy Canada Certificate Candidate


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