Sprains+and+Strains

What is a sprain?
An injury involving the stretching or tearing of a ligament (tissue that connects bone to bone) or a joint capsule, which help provide joint stability. A severely damaged ligament or joint capsule can cause instability in a joint. Sprains occur when a joint is forced beyond its normal range of motion, such as turning or rolling your ankle. Symptoms may include pain, inflammation/swelling, bruising, and in some cases, the inability to move a limb (arm, leg, foot).


 * Grade I Sprain:** causes overstretching or slight tearing of the ligaments with no joint instability. A person with a mild sprain usually experiences minimal pain, swelling, and little or no loss of functional ability. Bruising is absent or slight, and the person is usually able to put weight on the affected joint.
 * Grade II Sprain:** causes partial tearing of the ligament and is characterized by bruising, moderate pain, and swelling. A person with a moderate sprain usually has some difficulty putting weight on the affected joint and experiences some loss of function. An x-ray or MRI may be needed.
 * Grade III Sprain:** results in a complete tear or rupture of a ligament. Pain, swelling, and bruising are usually severe, and the patient is unable to put weight on the joint. An x-ray is usually taken to rule out a broken bone. This type of sprain often requires immobilization and possibly surgery. It can also increase the risk of an athlete having future sprains in that area.

What is a strain?
Strains are injuries that involve the stretching or tearing of a musculo-tendinous (muscle and tendon) structure. An acute strain of the musculo-tendinous structure occurs at the junction where the muscle is becoming a tendon. These strains take place when a muscle is stretched and suddenly contracts, as with running or jumping. This type of injury is frequently seen in runners who strain their hamstrings. Symptoms for an acute muscle strain may include pain, muscle spasm, loss of strength, and limited range of motion. Chronic strains are injuries that gradually build up from overuse or repetitive stress, resulting in tendinitis (inflammation of a tendon). For example, a tennis player may get tendinitis in his or her shoulder as the result of constant stress from repeated serves.


 * Grade I Strain:** This is a mild strain and only some muscle fibers have been damaged. Healing occurs within two to three weeks.
 * Grade II Strain:** This is a moderate strain with more extensive damage to muscle fibers, but the muscle is not completely ruptured. Healing occurs within three to six weeks.
 * Grade III Strain:** This is a severe injury with a complete rupture of a muscle. This typically requires a surgical repair of the muscle; the healing period can be up to three months.

Referral for X-ray
-Exacerbation of pain when stem of 128Hz tuning fork is applied to site of suspected fracture -Inability to weight bear

Biomedical Treatments
-Grade I injuries usually heal quickly with rest, ice, compression, and elevation (RICE). Therapeutic exercise can also help restore strength and flexibility. -Grade II injuries are treated similarly but may require immobilization of the injured area to permit healing. -Grade III sprains and strains usually require immobilization and possibly surgery to restore function. -NSAID’s are commonly prescribed at all stages for pain and inflammation

TCM Disease Classification
Niŭ Shāng : “sprain;” in traditional Chinese medicine, strains and sprains are collectively referred to as shāng jīn or “damage to sinews.” The term sinews (jīn) refers to a variety of anatomical structures including tendons, ligaments, muscles, joint capsules, bursa, fascia, tendon sheaths, skin, subcutaneous tissue, vessels, nerves, and cartilage. The TCM disease “sprain” (Niŭ Shāng), therefore, is a type of soft tissue injury that encompasses strains as well as sprains.

TCM Etiology and Pathogenesis
1) Trauma: damage to sinews from blows or collisions, falls, sudden movement for heavy lifting cause local stagnation of Qi and Blood with symptoms of pain and restricted movement. 2) Overuse: repeated taxation of a joint or set of muscles causes stagnation of Qi and Blood and, over time, lack of nourishment to the channels and collaterals and tissues of the affected structures. 3) Exogenous pathogens: Wind-Cold-Damp pathogens can take advantage of local and/or systemic deficiency of Defensive Qi and Blood and invade the channels and collaterals, exacerbating Qi stagnation and Blood stasis, increasing pain, and hindering healing. 4) Chronic illness, aging: Liver and Kidney vacuity due to aging or chronic illness leads to decline of Qi, Blood, and Essence resulting in lack of nourishment to the sinews. This makes one more susceptible to strains and strains.

Qi Stagnation and Blood Stasis
Herbal Treatment: Shu Jin Huo Xue Tang + Yunnan Bai Yao
 * Symptoms:** localized pain, swelling and possible bruising with restricted ROM; in chronic cases symptoms are aggravated by overwork or exposure to cold or drafts
 * Treatment Principles:**Move Qi, quicken the Blood, soothe the sinews, open the channels and collaterals, relieve pain

With Underlying Liver and Kidney Vacuity
Herbal Treatment: Bu Shen Zhuang Jin Tang
 * Symptoms:** localized pain, swelling and possible bruising with restricted ROM in an elderly patient; in chronic cases symptoms are aggravated by overwork or exposure to cold or drafts
 * Treatment Principles:** Supplement the Liver and Kidney, dispel Wind and Dampness, quicken Blood, open the channels and collaterals, relieve pain

In the later stages of sprains/strains or in cases of chronic sprains/strains, it is common for Wind, Cold and Damp pathogens to exploit local Qi and Blood vacuity and invade the channels and collaterals. In such cases, pain, swelling, and stiffness will be exacerbated during cold, damp weather. The prepared medicine Xiao Huo Luo Dan is commonly in such cases.

Acupuncture Treatment
Shoulder: LI15, TB14, SI10, SI9, Jian Qian Elbow: LI11, LU5, PC3, HT3, LI10, TB10, SI8 Wrist: LI5, TB4, PC7, LI4, TB5 Fingers: Ba Xie, LI4, LI3, TB3, Si Feng Hip: GB30, GB29, GB34, ST31, Huan Zhong Sacrum: BL32, BL27, BL28 Low back: BL23, BL27, BL28 Knee: ST35, Nei Xi Yan, ST34, BL40, GB33, LV8, GB34, SP9, KI10, SP10, He Ding Ankle: BL60, KI3, ST41, GB40, SP5, KI6 Toes : Ba Feng, ST44, SP3 Spine: GV14, GV12, GV3, Jia Ji Neck: GB20, BL10, BL11, Jia Ji
 * General Points for Qi stagnation and Blood stasis:** SP10, BL17, 4 Gates
 * Local points (based on the location of injury):**

SI3 + BL62 GB41 + TB5 LU7 + KI6
 * Distal Points (based on channel):**


 * Ear Acupuncture:** based on location of injury
 * Wei Liu Scalp**: good for acute pain
 * Bleeding:** Jing-Well points
 * Moxa**: after 4-7 days

Topical Preparations for Sprains and Strains at OCOM
Chili Plaster Eagle Brand Medicated Oil Jako Plaster Kwan Loon Oil Po Sum On Qi Ye Lian Analgesic White Flower Oil Wu Yang Plaster Yunnan Pai Yao Plaster & Liniment Zheng Gu Shui Aztec Hot Plaster

General Therapeutic Treatment
Jet Showers

Orthomolecular Treatment
-Chondroitin