Chiropractic Forensics
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William Cockburn,D.C.
It is very important to differentiate sprain injuries from strain injuries, unless of course, when they appear in tandem, which is most often the case. A great source of confusion and conjecture, the use of the term sprain as related to a simple "soft tissue injury" is not appropriate and can severely reduce the impact of recognition that a serious injury has been produced.
A "strain" for all practical purposes is a simple soft tissue injury, generally of muscle. It is self limiting, generally heals without complication and responds rapidly to ice, rest, massage and in some cases nutritional support.
A "SPRAIN" on the other hand is a significant soft tissue injury, occurring in ligaments, and is generally a non reversible permanent injury to the supporting structures to which ligaments connect. Ligament injuries {sprains} generally do not heal fully, produce long term degenerative effects upon the tissues they are meant to support, and often lead to serious impairment of body parts.
I have always explained to my patients, adjusters, attorneys and at trial, that a soft tissue injury is often termed a bruise that heals, and we have all had a bruise, haven't we. However, a "sprained" ankle produces severe pain, swelling, discoloration, dysfunction and the need for more intense treatment.
Due to the fact that the joints of the spine are so small, sprains are not visualized as they are in an ankle. While many professional athlete's have lost their careers due to sprains of the ankle, knee, wrist or shoulder, the impact of the facet Sprain or cervical spine Sprain is no less threatening. In fact, due to the mobility and spinal cord protection functions of the spine, when a sprain occurs, great care in the appropriate diagnosis and treatment must take place.
Sprains are not self-limiting, resolvable conditions, and must be viewed for the destructive lesion that they are, especially when related to spinal trauma.
An example of the new awareness of the significance of sprain injuries is the "loss of motion segment integrity" whole person impairment factors ratable in the 4th edition of the AMA Guides to the Evaluation of Permanent Impairment. A slippage of a vertebrae in excess of the standard placed by the guides (for example, 3.5mm [c-spine] between flexion and extension) rates as a 25% whole person impairment.
Sprains, are not simple soft tissue injuries. Modern technologies such as computer assisted x-ray digitizing offer the most reliable proof that a sprain exists, and is of great benefit to the treating doctor in his appropriate diagnosis and prognosis of his patients.
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