Understanding Ligament Injuries, Sprains and Strains and Where to Get Treatment

Ligament injuries, strains, and sprains are common musculoskeletal issues caused by overstretching or tearing. Ligaments are the connective tissues that hold two bones together and stabilise joints. These injuries range in severity from mild strains to complete tears and are frequently encountered in active individuals and athletes.

Ligament sprains occur in ligaments in all areas of the body. This article discusses specific ligament injuries in more detail under the condition. The information provided in this article is general information on ligament sprains. 

What is a Ligament Injury/Strain/Sprain?

  • Ligament Injury: Any damage to the ligaments, including stretching, partial tearing, or complete rupture.
  • Strain: This term generally refers to muscle or tendon injuries, but when involving ligaments, it often describes a stretched ligament with minor damage.
  • Sprain: Specific to ligaments, this occurs when a joint is suddenly twisted or impacted, causing stretching or tearing of the ligament.

Note sprain and strain are often used interchangeably to mean the same thing. 

What Are the Types of Ligament Injuries?

Types of Ligament Injuries

Ligament injuries range from minor stretches to complete tears and can be categorised based on severity, nature, and impact. Here are the main types:

1. Sprains

  • Grade I (Mild): The ligament is overstretched but not torn, with minimal swelling and mild pain. Joint stability is usually intact.
  • Grade II (Moderate): The ligament experiences a partial tear. This injury causes more significant pain, swelling, bruising, and joint instability.
  • Grade III (Severe): This is when the ligament is completely torn. This results in significant swelling, pain, bruising, and often, total joint instability. Surgical repair may be required.

2. Strains (When Referring to Ligaments, Though Typically Used for Muscles/Tendons)

  • Acute Strains: Result from sudden, forceful trauma or overextension of the ligament. Often seen in high-impact sports or accidents.
  • Chronic Strains: Develop gradually due to repetitive stress on the ligament, common in sports or jobs involving repetitive movements. Chronic strains may weaken the ligament over time, making it more susceptible to acute injury.

3. Complete Tears

  • In complete ligament tears, the ligament separates entirely, often causing the joint to become unstable and unable to function normally. Depending on the location and severity, this injury may need surgical intervention.

4. Partial Tears

  • A partial tear occurs when the ligament is only partially torn, but some fibres remain intact. Partial tears cause pain and swelling but may retain some joint stability. Treatment may vary from conservative approaches to surgical repair based on the injury’s extent.

5. Avulsion Fracture

  • In some cases, the ligament doesn’t tear but instead pulls a small fragment of bone away from its attachment point. This is called an avulsion fracture and is common in high-impact injuries. Treatment may vary depending on the bone and ligament involved.

Each type of ligament injury requires a tailored approach to treatment and rehabilitation, with more severe injuries needing structured therapy or surgery to restore function and stability to the affected joint.

How Common Are Ligament Injuries?

Ligament injuries are among the most frequent musculoskeletal injuries, especially in active individuals and athletes. They account for a significant proportion of sports-related injuries and emergency clinic visits. The prevalence of ligament injuries varies based on activity level and the specific joint involved, with certain high-risk sports and occupations increasing susceptibility.

Most Common Ligament Injuries

Here are some of the most commonly injured ligaments:

1. Anterior Cruciate Ligament (ACL) – Knee

  • The ACL is a common ligament to injure, particularly in sports involving sudden stops, twists, and direction changes, such as football, basketball, and soccer.
  • ACL tears are often serious, with partial or complete tears requiring extensive rehabilitation or surgery.
  • Prevalence: Hundreds of thousands of ACL injuries occur annually worldwide, with a high incidence among young athletes.

2. Medial Collateral Ligament (MCL) – Knee

  • The MCL works to stabilise the inner side of the knee and is frequently injured in contact sports, especially those involving lateral impact, such as rugby, football, and hockey.
  • MCL injuries can be mild sprains or complete tears but are often treated non-surgically.

3. Lateral Ankle Ligaments (ATFL, CFL) – Ankle

  • Ankle sprains, particularly affecting the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), are extremely common.
  • These injuries occur in sports involving jumping, running, or rapid changes in direction, such as netball, basketball, tennis, and volleyball.
  • Ankle ligament injuries are among the most frequently treated injuries in emergency departments.

4. Ulnar Collateral Ligament (UCL) – Thumb

  • The UCL of the thumb stabilises the metacarpophalangeal (MCP) joint and is commonly injured in activities involving falls, such as skiing (often termed “skier’s thumb”).
  • UCL tears often require surgical repair to restore thumb stability, especially in complete tears where the ligament may become displaced.

5. Acromioclavicular (AC) Ligament – Shoulder

  • The AC ligament connects the acromion and clavicle bones and is often injured in falls or high-impact activities, particularly in contact sports like rugby and wrestling.
  • AC injuries can range from mild sprains to severe separations, depending on the degree of ligament damage.

6. Rotator Cuff Ligaments and Tendons – Shoulder

  • While more often involving tendons, the ligaments and surrounding structures in the rotator cuff are prone to injury, especially in overhead sports like baseball, tennis, and swimming.
  • Repetitive strain can lead to partial or full tears, especially in older athletes.

7. Lateral Collateral Ligament (LCL) – Knee

  • Although less commonly injured than the ACL or MCL, the LCL can be injured from blows to the inner knee or in sports involving twisting motions, like skiing and soccer.
  • LCL injuries vary from mild sprains to severe tears, often occurring with other ligament injuries in complex knee trauma.

Summary

Ligament injuries are common across a wide range of sports and activities, particularly in the knees, ankles, thumbs, and shoulders. The most frequently affected ligaments, such as the ACL, MCL, ankle ligaments, and UCL, are often subject to repetitive strain or impact, making them vulnerable to sprains and tears in high-demand or high-impact movements. Proper conditioning, supportive equipment, and good technique can reduce the risk of these common injuries.

Access Ortho are specialist in the diagnosis and treatment of ligament injuries. Visiting Access Ortho will ensure you receive a rapid and accurate diagnosis, and treatment can begin as early as possible to minimise complications. Access Ortho is led by Orthopaedic Surgeons and designed to allow early access to orthopaedic care for acute injuries. 

Anatomy and Function

Understanding Ligaments: Structure and Function

Ligaments are strong, fibrous tissues. Ligaments connect bones at joints, providing stability and enabling movement. They play a crucial role in joint stability and are found throughout the body, particularly in the knees, ankles, wrists, and shoulders.

Common Sites of Ligament Injuries

Ligament injuries frequently occur in weight-bearing joints and those subjected to high-impact activities, such as:

  • Ankles
  • Knees (e.g., ACL, MCL)
  • Shoulders
  • Wrists and thumbs

Types of Ligament Injuries

Sprains: Grades and Severity

  • Grade I (Mild): Ligament is stretched, but not torn. It may cause mild pain and swelling.
  • Grade II (Moderate): Partial tear with moderate swelling and instability.
  • Grade III (Severe): Complete tear, resulting in significant instability and pain.

Strains: Acute vs. Chronic

  • Acute Strain: Sudden, forceful injury, often due to a fall or collision.
  • Chronic Strain: Develops over time with repetitive use or stress, especially in sports or occupations requiring repeated motions.

Complete Ligament Tears

When a ligament is completely torn, the joint may become highly unstable. Complete tears often require surgical intervention for repair and are most commonly seen in high-impact injuries, like ACL tears in the knee.

Prevalence and Epidemiology

How Common Are Ligament Injuries?

Ligament injuries one of the most common musculoskeletal injuries, particularly in sports and physically demanding activities. They account for a significant portion of emergency and orthopaedic clinic visits.

Access Ortho is an urgent orthopaedic injuries clinic that treats all upper and lower limb ligament injuries. 

Which Sports and Activities Have the Highest Risk?

High-risk sports include football, basketball, netball, rugby, soccer, skiing, and gymnastics, where rapid direction changes, impact, or falls are common.

Symptoms and Causes

What Causes Ligament Injuries?

Ligament injuries occur when a joint is forced beyond its normal range of movement, often due to:

  • Sudden twisting or pivoting
  • Direct impact or trauma
  • Overuse or repetitive strain

What Are the Risk Factors for Ligament Injuries?

  • Participation in high-impact sports
  • Poor conditioning or flexibility
  • Prior ligament injuries
  • Inadequate warm-up or technique

What Are the Symptoms of a Ligament Injury?

Symptoms of a ligament injury vary based on the severity and location of the injury. However, common symptoms include:

  1. Pain

Typically, ligament injuries cause pain immediately after the injury. The pain is often located around the affected joint and worsens with movement or pressure.

  1. Swelling and Bruising

Swelling often occurs soon after injury, as blood and fluid collect around the damaged ligament. Bruising may develop over hours or days, depending on the injury’s severity.

  1. Joint Instability

Ligaments help stabilise joints, so when they are injured, the affected joint may feel unstable, loose, or “wobbly.” This is particularly noticeable in weight-bearing joints like the knee or ankle.

  1. Limited Range of Motion

Injuries to ligaments may restrict the joint’s ability to move fully. For example, bending, straightening, or rotating the joint may be difficult or painful.

  1. Popping or Tearing Sensation

A popping or tearing sensation is sometimes felt or heard at the time of injury, especially in severe ligament tears like ACL injuries in the knee.

  1. Tenderness to the Touch

The area around the injured ligament may feel tender and painful to touch, making it difficult to apply pressure or palpate.

  1. Muscle Spasms or Cramping

In some cases, muscles surrounding the injured ligament may go into spasm, trying to compensate for the joint instability.

  1. Inability to Bear weight (in lower limb injuries)

For injuries involving the knee, ankle, or foot ligaments, it may be difficult or impossible to bear weight on the affected leg.

Severity of Symptoms by Injury Grade

  • Grade I (Mild): Minor pain and swelling, little or no joint instability.
  • Grade II (Moderate): Moderate pain, swelling, and bruising with some joint instability and limited motion.
  • Grade III (Severe): Intense pain, significant swelling and bruising, major instability, and often a complete inability to use the joint.

If any of these symptoms occur after an injury, especially joint instability or an inability to bear weight, it’s important to seek medical evaluation from someone specialising in orthopaedics to confirm the injury type and extent and receive appropriate treatment. 

Access Ortho is an urgent injuries clinic that specialises only in orthopaedics. Access Ortho offers rapid appointments for patients with known or suspected ligament injuries.

Potential Complications of Untreated Ligament Injuries

Leaving a ligament injury untreated or improperly treated can lead to various complications, which may cause long-term joint issues and impact mobility. Some potential complications include:

  1. Chronic Pain and Inflammation

Persistent pain and inflammation can develop as the joint becomes overworked or compensates for the instability caused by the damaged ligament. Chronic pain may affect quality of life and limit physical activity.

  1. Joint Instability

Without proper treatment, the joint may remain unstable due to the weakened or torn ligament. This instability increases the risk of further injuries, such as recurrent sprains, fractures, or dislocations.

  1. Arthritis

Long-term joint instability and abnormal wear on joint surfaces can increase the risk of osteoarthritis in the affected joint. This is particularly common in untreated knee and ankle ligament injuries, where the joint’s alignment is compromised.

  1. Loss of Range of Motion

Scar tissue can develop around the injured ligament, causing stiffness and reduced flexibility in the joint. This restriction in movement can make it challenging to perform everyday tasks and may reduce athletic performance.

  1. Muscle Weakness and Atrophy

If the injury is left untreated, limited joint use may lead to muscle weakening and atrophy around the affected area. This loss of strength makes the joint even more prone to further injury and can make recovery more difficult if treatment is eventually pursued.

  1. Recurring Injuries

Untreated ligament injuries increase the likelihood of repeat injuries due to the compromised stability and function of the joint. For example, untreated ankle sprains can lead to chronic ankle instability, resulting in frequent sprains or falls.

  1. Impaired Physical Performance

An untreated ligament injury can limit athletic performance and make engaging in certain physical activities challenging. Athletes, in particular, may struggle with reduced agility, strength, and endurance.

  1. Nerve Damage

In some cases, untreated ligament injuries can lead to nerve damage, especially if swelling or instability compresses nearby nerves. This may lead to numbness, tingling, or weakness in the surrounding area.

  1. Joint Deformity

Severe cases of untreated ligament injuries, especially those affecting weight-bearing joints, may lead to joint deformities. Over time, misalignment and uneven wear can cause the joint structure to change shape.

Summary

Prompt diagnosis and treatment of ligament injuries are essential to avoid these complications. Early intervention, whether through conservative measures or surgical repair, can restore joint stability, prevent long-term damage, and ensure a quicker and more complete recovery.

Access Ortho offers rapid access to orthopaedic surgeons. 

Diagnosis and Tests for Ligament Injuries

Diagnosing ligament injuries requires a combination of clinical assessment and imaging studies to confirm the extent and location of the damage. Here is an overview of the main steps:

How Are Ligament Injuries Diagnosed?

Ligament injuries are diagnosed through a thorough clinical examination and confirmed with imaging studies if necessary. The diagnostic process usually includes:

  • Patient History: The medical staff will ask about the injury’s cause, symptoms, and any previous joint issues.
  • Physical Examination: This includes evaluating joint stability, range of motion, and specific tests to assess ligament integrity.
  • Imaging Studies: Imaging, such as X-rays, MRIs, or ultrasound, may be used to confirm the injury and assess severity.

Physical Examination Techniques for Ligament Injuries

  1. Palpation

The medical provider will palpate (gently press) around the injured area to identify tender points, swelling, and signs of instability.

  1. Range of Motion (ROM) Tests

The joint’s range of motion is tested to check for pain, stiffness, or limitations. Restricted movement may indicate ligament damage or joint injury.

  1. Stability Tests

Specific stability tests are used to assess the integrity of the ligament:

  1. Anterior Drawer Test (ankle, knee): Pulls the joint to detect ligament laxity, often used for ACL or ankle ligament injuries.
  2. Lachman Test (knee): A quick, precise method to assess the ACL in the knee.
  3. Varus and Valgus Stress Tests (knee, elbow): Side-to-side pressure is applied to test the medial and lateral ligaments.
  4. Specialised Joint Tests
    1. Each joint has unique tests:
      1. Thompson Test (Achilles): Squeezing the calf checks for Achilles tendon or ligament rupture.
      2. McMurray’s Test (knee): Manipulating the knee can reveal potential meniscus or ligament issues.
      3. Finkelstein Test (wrist): Determines if pain is due to ligament or tendon involvement in the wrist.

Imaging Studies Used to Confirm Ligament Injuries

  1. X-ray

X-rays are useful for ruling out bone fractures and identifying ligament avulsion fractures (where the ligament pulls a piece of bone away).

X-rays are less effective for detecting soft tissue injuries but are usually the first imaging study performed.

  1. Magnetic Resonance Imaging (MRI)

MRI is the preferred imaging method for visualising soft tissue injuries, including partial or complete ligament tears.

MRI provides detailed images of ligaments, tendons, cartilage, and other soft tissues, making it ideal for assessing the severity of ligament injuries.

  1. Ultrasound

Ultrasound is a non-invasive radiology option that can identify ligament tears, particularly in smaller joints such as the wrist, ankle, and elbow.

It is especially helpful in real-time dynamic testing, where the joint can be moved during imaging to assess ligament integrity.

Ligament Injuries
MRI’s are used to view the soft tissues and help diagnose ligament injuries

Specific Considerations for Different Joint Injuries

  • Knee
    • Common Injuries: ACL, MCL, PCL, and LCL tears.
    • Preferred Diagnostic Tools: MRI is standard, with specific stability tests (Lachman, Anterior Drawer) helping to evaluate ligament function.
  • Ankle
    • Common Injuries: ATFL, CFL, and deltoid ligament sprains.
    • Preferred Diagnostic Tools: Physical examination (anterior drawer test) and MRI for soft tissue assessment.
  • Wrist and Thumb
    • Common Injuries: Ulnar collateral ligament (UCL) injuries in the thumb, scapholunate ligament tears in the wrist.
    • Preferred Diagnostic Tools: Ultrasound is useful for smaller ligaments, while MRI may be used for severe or complex injuries.
  • Shoulder
    • Common Injuries: AC joint, rotator cuff, and labral tears.
    • Preferred Diagnostic Tools: MRI for detailed soft tissue imaging; physical tests like the apprehension test help assess stability.

Diagnosing ligament injuries relies on a combination of physical assessments and imaging to confirm the injury type and severity, guiding appropriate treatment. Accurate and rapid diagnosis requires orthopaedic input to determine the extent of the injury and the best course of treatment. 

Management and Treatment

How Are Ligament Injuries Treated?

Treatment depends on the injury’s severity and may range from rest and physiotherapy to surgery for severe tears.

Conservative Treatment Options

  • RICE Method: This involves using Rest, Ice, Compression, and Elevation to reduce swelling and pain.
  • Medications: Anti-inflammatory drugs may be recommended for pain relief.

Physiotherapy: Essential for restoring mobility, strength, and joint stability.

Ligament Injuries
Ice helps to minimise pain and swelling following a ligament injury

Surgical Interventions for Severe Ligament Injuries

Surgery may be necessary for Grade III sprains, complete tears, or when conservative treatments fail.

A full assessment is required before a decision regarding surgery is made. The decision will be made considering the patient’s age and activity levels. 

Rehabilitation Protocols for Ligament Injuries

Rehabilitation focuses on restoring joint function through a structured program of mobility, strengthening, and proprioceptive exercises.

All rehabilitation for ligament injuries should be done under the guidance of your medical team. 

Prevention

How Can I Prevent Ligament Injuries?

Prevention includes conditioning, using proper techniques, and warming up before activities.

Proper Warm-Up and Training Techniques

Warming up improves flexibility and prepares muscles and joints for activity, reducing injury risk.

Protective Equipment for High-Risk Activities

Using braces or taping in sports and high-impact activities provides additional joint stability.

Outlook / Prognosis

What Can I Expect if I Have a Ligament Injury?

With appropriate treatment, many ligament injuries heal well, but severe cases may require longer recovery and specialised rehabilitation.

It is essential to seek orthopaedic care for ligament injuries to ensure the best treatment plan is in place. Access Ortho offers rapid appointments for the diagnosis and treatment of ligament injuries.

Recovery Time for Different Types of Ligament Injuries

Recovery varies by severity:

  • Grade I: A few weeks of rest and rehabilitation
  • Grade II: Several weeks to a few months
  • Grade III: May require surgery and several months of recovery

Long-Term Outcomes and Potential Complications

Most individuals regain full function, though severe injuries may lead to chronic instability or arthritis if not properly treated. It is, therefore, essential to get expert advice. Access Ortho is staffed by a medical team skilled in caring for orthopaedic patients and is led by orthopaedic surgeons. 

When to Seek Medical Attention

When Should I Go to a Clinic for a Potential Ligament Injury?

Seek medical care if you experience pain, swelling, or instability in a joint that doesn’t improve after a few days of rest and self-care or, more urgently, if symptoms are severe or you cannot bear weight. 

Red Flags: When Immediate Medical Attention Is Necessary

Seek immediate care if you notice:

  • Severe pain and swelling
  • Visible deformity
  • Inability to move the joint
  • Numbness or tingling in the affected area

Who should I see for Ligament Injury Management?

Knowing where to go when you have a ligament injury can be difficult. Emergency departments offer immediate care but do not offer the required orthopaedic follow-up care you will need. Urgent Care Clinics are the same as emergency departments. You will not get orthopaedic follow-up care at these clinics. 

Your GP will offer excellent advice and immediate care, but you will require a referral to an orthopaedic surgeon to discuss the need for surgery or conservative treatment.

A private Orthopaedic surgeon can give you excellent advice, but it can take weeks to get an appointment, and you will need to see your GP first for a referral.

Access Ortho is a private fracture clinic that offers immediate and follow-up orthopaedic care in the clinic. This means that you can rapidly get an expert orthopaedic opinion without waiting and also be fitted for splints, casts, etc., that you may need for urgent immobilisation. 

Access Ortho can provide your follow-up orthopaedic care if you have already seen a GP, ED or Urgent Care clinic. If you require surgery, Access Ortho will organise a direct referral to a public hospital, or you can stay in the private system. This process will ensure you get surgery rapidly if required. 

Sports medicine clinics can advise on your injury but do not manage surgery. You will require an orthopaedic surgeon to advise you on this. Access Ortho is led by orthopaedic surgeons.

Orthopedist examining patient in clinic

What to Expect During Your Clinic Visit

At the clinic, you’ll undergo a thorough evaluation, potentially including imaging and stability tests, to develop a tailored treatment plan.

A treatment plan will include initial care, such as immobilisation, crutches, advice on ice, and pain relief. The need for surgery will also be discussed. This decision may be made at your first visit or when you return to the clinic and see the orthopaedic surgeon for follow-up care. Follow-up visits are made promptly to ensure the best care for the injury. 

How do I see an orthopaedic surgeon quickly for my injury?

Getting an urgent appointment with an Orthopaedic surgeon can be very difficult. Access Ortho helps solve this problem. Access Ortho is led by Orthopaedic Surgeons, and cases are discussed with the surgeon on the day they present. Follow-up care is provided by the orthopedic surgeons in the clinic. 

You do not need a referral to attend Access Ortho, so it is a rapid way to get Orthopaedic advice. Access Ortho is affordable compared to private emergency departments and private orthopaedic surgeons. 

Commonly Asked Questions

How do I know if I’ve sprained a ligament or if it’s just sore?

Ligament sprains often cause noticeable swelling, bruising, and joint instability, while soreness is typically mild and resolves quickly.

Can I walk on a sprained ankle?

It depends on the severity. Mild sprains may allow limited movement, but moderate to severe sprains require rest and limited weight-bearing.

How long does it take for a ligament injury to heal?

Recovery varies by injury type, from a few weeks for mild sprains to several months for severe tears.

Will I need surgery for my ligament injury?

Surgery is generally needed only for complete tears or when conservative treatments fail to provide stability. Orthopaedic advice is required to determine if you should have surgery.

What’s the difference between a sprain and a strain?

A sprain affects ligaments and a strain involves muscles or tendons. However, these terms are often used interchangeably when discussing injuries.

Can ligaments heal on their own?

Some mild sprains can heal well with rest and care, but complete tears often need medical intervention.

How can I speed up recovery from a ligament injury?

Following your rehabilitation plan, avoiding stress on the joint, and engaging in safe physiotherapy can help speed recovery.

Are some people more prone to ligament injuries?

Individuals with ligament laxity, previous injuries, or who participate in high-impact activities may be more susceptible.

What exercises are safe to do with a ligament injury?

Low-impact exercises, as advised by your physiotherapist, are typically safe and beneficial for recovery.

How can I prevent re-injury after recovering from a ligament injury?

Strengthening and conditioning exercises, proper warm-up, and supportive equipment help prevent re-injury.