Sprains, Strains, and Other Soft-Tissue Injuries

The most commonly injured soft tissues are muscles, tendons, and ligaments. These injuries often occur during sports and exercise activities, but sometimes the simple activities of everyday life can cause an injury.

Sprains, sprains, and bruises, as well as tendinitis and bursitis, are common soft tissue injuries. Even with proper treatment, these lesions can take a long time to heal.


Soft tissue injuries fall into two basic categories: acute injuries and abuse injuries.

  • Acute injuries are caused by a sudden trauma, such as a fall, a twist, or a blow to the body. Examples of acute injuries include sprains, sprains, strains and contusions.
  • Abuse injuries occur gradually over time, when an athletic or other activity is repeated so often that areas of the body do not have enough time to heal between incidents. Tendinitis and bursitis are common soft tissue injuries.

Common acute soft tissue injuries

Acute soft tissue injuries vary in type and severity. When an acute injury occurs, initial treatment with the RICE protocol is usually very effective. RICE stands for Rest, Ice, Compression, and Elevation.

  • Rest. Take a break from the activities that caused the injury. Your doctor may recommend that you use crutches to avoid putting weight on your leg.
  • Ice. Use cold compresses for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
  • Compression. To prevent further swelling and blood loss, use an elastic compression bandage.
  • Elevation. To reduce inflammation, elevate the injury higher up on the heart while resting.


A sprain is a stretch and/or tear of a ligament, a strong band of connective tissue that connects the end of one bone to another. Ligaments stabilize and support the body’s joints. For example, ligaments in the knee connect the femur to the tibia, allowing people to walk and run.

The areas of the body most vulnerable to sprains are the ankles, knees, and wrists. An ankle sprain can occur when your foot turns inward, putting extreme stress on the ligaments of the outer ankle. A knee sprain can be the result of a sudden twist, and a wrist sprain can occur when you fall with your hand stretched out.

Sprains are classified by their severity:

  • Grade 1 (mild) sprain: Light stretching and some damage to the fibers (fibrils) of the ligament.
  • Grade 2 sprain (moderate): Partial tear of the ligament. There is abnormal loosening (laxity) in the joint when it moves in certain ways.
  • Grade 3 sprain (severe): Total tearing of the ligament. This causes significant instability and makes the joint non-functional.

Although the intensity varies, pain, bruising, swelling, and inflammation are common in all three categories of sprains. Treatment of mild sprains includes RICE and sometimes physical therapy exercises. Moderate sprains often require a period of immobilization. More severe sprains may require surgery to repair torn ligaments.


A sprain is an injury to a muscle and/or tendons. Tendons are fibrous cords of tissue that join muscles to bone. Sprains often occur in the foot, leg (typically in the thigh muscles), or back.

A severe injury to the thigh muscle where the tendon has torn from the bone.
Severe injury to the thigh muscle where the tendon has torn from the bone.

Similar to sprains, sprains can be a simple strain on the muscle or tendon, or they can be a partial or complete tear in the combination of muscle and tendon. Typical symptoms of a sprain include pain, muscle spasms, muscle weakness, swelling, inflammation, and cramps.

Soccer, football, hockey, boxing, wrestling, and other contact sports pose sprain risks for athletes, as do fast-start sports such as obstacle courses, long jumps, and runs.

Gymnastics, tennis, canoeing, golf, and other sports that require excessive grasping have a high incidence of hand sprains. Sprains in the elbows frequently occur in racquetball, pitching, and contact sports.

The recommended treatment for a sprain is the same as for a sprain: rest, ice, compression, and elevation. This should be followed by simple exercises to relieve pain and restore mobility. Surgery may be required for a more severe tear.

Contusions (hematomas)

A contusion is a hematoma caused by a direct blow or repeated blows, crushing of the underlying muscle fibers and connective tissues without breaking the skin. A contusion can result from falling or crashing the body against a hard surface. The skin spot is caused by blood accumulating around the lesion.

Most contusions are mild and respond well to the RICE protocol. If symptoms persist, seek medical attention to prevent permanent soft tissue damage.


Tendinitis is an inflammation or irritation of a tendon or the covering of a tendon (called a sheath). It is caused by a series of stresses that repeatedly attack the tendon. Symptoms typically include inflammation and pain that worsens with activity.

Small tears in the Achilles tendon cause it to swell and thicken.
Small tears in the Achilles tendon cause it to swell and thicken.

Baseball players, swimmers, tennis players, and professional golfers are susceptible to tendonitis in the shoulders and arms. Soccer and basketball players, runners, and aerobic dancers are prone to tendon swelling in the legs and feet.

Tendinitis can be treated with rest to eliminate exertion, anti-inflammatory medications, steroid injections, splints, and exercises to correct muscle imbalance and improve flexibility. Persistent inflammation can cause significant damage to the tendon, which may require surgery.


Bursas are small, gelatinous bags that are located throughout the body, including around the shoulder, elbow, hip, knee, and ankle. They contain a small amount of fluid, and are positioned between the bones and soft tissues, acting as cushions to help reduce friction.

Bursitis is the inflammation of a bursa. Repeated small efforts and abuse can cause the bursa to become inflamed in the shoulder, elbow, hip, knee, or ankle. Many people experience bursitis in association with tendinitis.

Bursitis may be relieved by changes in activity and possibly anti-inflammatory medications, such as ibuprofen. If inflammation and pain do not respond to these measures, your doctor may recommend removing fluid from the bursa and injecting a corticosteroid medication into the bursa.

The steroid drug is an anti-inflammatory drug that is stronger than the drug that can be taken orally. Corticosteroid injections usually work well to relieve pain and inflammation.

Although surgery is rarely needed for bursitis, if the bursa becomes infected, an operation to drain the fluid from the bursa may be necessary. In addition, if the bursa remains infected or the bursatis returns after all non-surgical treatments have been tried, your doctor may recommend removal of the bursa.

Removal (excision) of the bursa may be done using a standard incision (open procedure), or as an arthroscopic procedure with small incisions and surgical instruments. Your doctor will talk with you about the best procedure for your medical needs.