What’s the Difference Between a Strain, a Sprain, and a Fracture?

Whooshing down the slopes. Springing from a trampoline. Running down the field at full speed. We push our bodies to the limit on a regular basis, and sometimes we pay for it with lingering pain afterward. But when is that discomfort a strain, a sprain, or a fracture? And is there really a big difference between the three?

Short answer: Yes.

To explain the nuances of these common diagnoses, we turned to an expert: Daniel W. Green, MD, Director of the Pediatric Sports Program for the Division of Pediatric Orthopedic Surgery at Hospital for Special Surgery.

For starters, if you’ve ever used the words “sprain” and “strain” interchangeably to describe a lingering pain, you’re hardly alone. The mistake is so common that Dr. Green says he doesn’t even bother correcting patients who make it. But while the words sound fairly similar, their definitions and treatments are not.

Strains

A strain is a stretching or tearing of a muscle or tendon (the tissue that attaches the muscle to the bone). Symptoms include pain and swelling and difficulty moving the affected area. A strain can happen virtually anywhere—falling on the playground, overdoing it on the athletic field—but Dr. Green sees an increase during track and field season, when first-time athletes dive into high-demand activities like sprinting and hurdles without properly stretching first.

Treatment is mostly DIY and exclusively aimed at offering comfort. Think massage, heat, stretching, and rest. “For a runner with a muscle strain, we don’t want them to run, jump, and sprint until they can stretch and walk comfortably,” he says. Meanwhile, proper stretching and warm-ups can help prevent future injury.

Sprains

A sprain is a stretching or tearing of the ligament, the soft tissue structures that hold joints together and restrict or constrain movements within the joints. It can range from very mild to significant. Like a strain, sprains result in discomfort, swelling, and limited mobility in the affected area, and can occur in a variety of settings, including activities that involve lots of pivots and direction changes, like skiing and football.

Treatment depends on which ligament is injured and could include bracing to protect the injured area and allow it to heal. Injury-prevention regimens help, and can run the gamut from exercises that strengthen the core and increase flexibility to teaching athletes how to jump, land and control their core when they pivot or change directions. But to reap the full benefits, you have to stay committed to the program, Dr. Green says. Even a six-month break is enough to undo your hard work.

Fractures

A fracture is an injury to the bone, and it can hurt—a lot. “Sometimes the damage to the bone can be extremely mild, and sometimes it can be like a stick snapped in half,” he says. (Ouch!)

A diagnosis is typically made after a physical exam and imaging, such as an x-ray, MRI, or ultrasound. The majority of fractures are treated with rest and immobilization and, in some cases, surgery. But, as Dr. Green points out, “each fracture and part of the body has different rules and orthopedic plans and algorithms based on the type and degree of the fracture. Some require surgery, and some just need two or three weeks of immobilization.”