As in many professions, there are many schools of thought in what is “correct” or the “best course of treatment.” This is why medicine can be, despite all our best efforts, so subjective; every human is different, every injury is different, and every recovery is different. Even the same injury in the same person can have vastly different recoveries. We try to be as objective as possible, but just know that some of the following can be treated in a variety of ways and this speaks to the complexity of the human body and our continuously growing knowledge in science and medicine.
SPRAIN vs. STRAIN
This is maybe the most common, and it’s more a matter of terminology than incorrectness. A sprain refers to an injury to a ligament. Ligaments connect bone to bone, such as in the ankle or knee; there are ligaments in every joint in the body. A strain refers to an injury to a muscle or tendon, often referred to colloquially as a “pulled muscle.” Tendons connect muscle to bone; muscles, of course, move our bodies through space. This is a minor difference, but the injuries can be very different. Sprains are usually associated with swelling, stiffness, loss of range of motion and could be considered more serious in some cases. Strains are usually accompanied by pain with active motion, and sometimes passive motion, and may or may not include swelling and bruising. The severity of each of these injuries range from mild to severe, and the length of recovery time depends on both the demands of a sport/activity and the body part involved. A strained forearm muscle will likely take less time to heal than a strained hamstring muscle.
“FRACTURED” vs. “BROKEN”
Believe it or not, I have had multiple athletes come up to me following x-rays and say, “The ER told me it was just fractured, not broken.” These athletes are often shocked when I tell them that fractured and broken are exactly the same thing. I’m not sure if it is just a miscommunication (athletes often hear what they want to hear) or what, but when a bone is broken, it is fractured.
“POPPING” vs. CREPITUS
A common complaint from athletes and non-athletes alike is of a “cracking” or “popping” in a joint. This can be either nothing or quite serious, depending on what causes it, how long it has been occurring, if there was associated trauma, and whether or not it is painful. My knees crack everytime I get into a deep squat. Occasionally, I will get a non-painful pop in my shoulder or wrist. My hips usually pop audibly when I stand after sitting for a long time. These are not serious or indicative of a serious issue, as they occur consistently, are not painful and are not associated with trauma. When I was a kid, there was a rumor that cracking your knuckles causes arthritis, when in reality, these are the same type of “Rice Krispies” pops that occur in several joints in my body on a regular basis. They are normal, relieve pressure and often make me feel better after. This type of “cracking” is often the sign of a well-lubricated joint.
Crepitus, on the other hand, is the medical term for abnormal cracking or popping. This can be palpable and/or audible, but often occurs during evaluation of an injury or with certain motions. Crepitus along a bone can be indicative of a fracture. Crepitus with certain knee or shoulder motions, often described as catching or clicking, can be indicative of a cartilage or muscle tear. These are often painful or uncomfortable and can be reproduced in a clinical evaluation. There can also be crepitus at the site of swelling or scar tissue. These more serious cracks and pops should be evaluated by a medical professional and are often followed up with imaging. If you’re uncertain about whether it is an issue that warrants a visit to the doctor, this would be a great use of the 15-minute Complimentary Consultations offered by The Center for Physical Rehab at our 5 locations. One of our physical therapists will be able to advise further medical intervention or imaging if they deem appropriate. If your child has an athletic trainer, they often can be seen before a doctor to save a visit/co-pay when possible.
There was a time in the past when concussions were graded (1-3) as either mild, moderate or severe. More recently, we have moved away from grading concussions, and just call it what it is: a brain injury. As concussions do not show up on any type of imaging and are hard to predict as far as signs/symptoms and recovery time, it is very hard to grade a concussion until after it has resolved. One could describe the severity in terms of how long it kept a person from activity, but an athletic trainer or sports medicine doctor will say you’re usually either concussed or you’re not. No matter the grade of concussion, an athlete should not return to sport until they have been cleared by a sports medicine doctor and completed a graduated return to play program.
“I CAN’T SLEEP AFTER A CONCUSSION”
Speaking of concussions, this was another adage from the past that has stuck around, despite the fact that treatment of concussions has evolved quite a bit over the years. The intention behind this was that, if someone hits their head, they could have a brain bleed, if one goes to sleep with a brain bleed, there is a possibility of coma and potentially death. This is obviously cause for concern, and is grounded in fact. However, most concussions, especially in sports, are not accompanied by a brain bleed. Unless an athletic trainer or other medical professional says otherwise, there is usually no need to wake a person frequently that night or the following nights. Sleep is usually all a person with a headache wants to do, and it is likely restorative if they are concussed. It gives the brain a chance to slow down and recharge, as it is overstimulated in the event of a brain injury. That being said, whenever possible, a head/brain injury should be assessed prior to going to sleep, as mental status and condition can deteriorate rather quickly and cannot be monitored accurately if someone is asleep. Concussion diagnosis is among the most subjective among the healthcare professions, and should only be performed by someone trained in current practices.
BONE BRUISE vs BRUISE
Just about every person has had a bruise, or a contusion, in their lifetime. A bruise is caused by blunt trauma, and causes a localized discoloration due to small capillaries being broken and spilling their contents into the surrounding tissues. They are tender to the touch but do not restrict motion and usually only last a few days. I often get them on my thighs when bumping into the edges of desks or tables. These bruises are usually superficial and can occur in “soft” areas like fat or muscle or on prominent bony places like elbows.
A deeper muscle contusion can cause restrictions in range of motion and swelling, these usually occur in the larger muscle groups like the quadriceps with more forceful or penetrating blunt trauma (a knee or cleat to the quad) and are more debilitating.
A bone bruise can occur in many circumstances, but two stick out in my mind. The more obvious of the two would be some sort of high-velocity contact with a prominent bone. Examples of this would include a softball to the shin bone or getting slashed by a lacrosse stick on the wrist. The second kind often accompanies a more traumatic injury such as a ligament sprain or complete tear. When an football player lands on a hyperextended knee or when a person’s shoulder reduces or relocates following a dislocation, these abnormal joint positions can cause injury to the bone within the joint. A bone bruise can mean either the superficial kind that turn purple, or the deep kind that can’t always be seen. These are diagnosed by exam and/or x-ray and affect the entire joint. The recovery time for these is often longer than a different type of bruise, due to the depth and impact on the bone itself.
There are many more of these examples, but these are the most often mixed-up or mistaken. If you have questions or concerns about your joints following an injury, always seek medical advice from your doctor or physical therapist. Generally, the earlier an injury is addressed, the shorter the recovery time. It’s usually better to be reassured that a twinge is nothing, than to find out later that it was something bigger or has since worsened. This is another reason we offer our 15-minute Complimentary appointments; so the general population has access to a medical professional’s opinion.