Sports Injuries
Strains, Sprains, and Overuse Injuries: What Athletes Need to Know Before Returning to Play
Strains, sprains, and overuse injuries are the most common reason athletes end up missing practice, and rushing back too early is the most common reason they get hurt again. Here is how to tell what you are actually dealing with, what the first few days should look like, and how to know you are really ready to play.
By Dr. Edward Johns, DC · September 7, 2026 · 7 min read
Strain or Sprain? The Difference Actually Matters
The words get used interchangeably around the field or the gym, but a sprain and a strain are not the same injury. A sprain is damage to a ligament, the band of tissue that connects one bone to another and holds a joint together. Ankles, knees, and wrists are the usual spots. A strain is damage to a muscle or tendon, the tissue that connects muscle to bone, and it shows up more in the hamstring, groin, calf, or lower back.
Knowing which one you are dealing with matters, because it changes what the recovery actually looks like, even though both get evaluated and graded the same way.
- Sprain: ligament injury, usually at a joint like the ankle, knee, or wrist
- Strain: muscle or tendon injury, common in the hamstring, groin, calf, or lower back
- Both can happen from a sudden twist or from repeated overload over time
Grading the Injury: Mild, Moderate, or Severe
Both sprains and strains get sorted into the same three grades, and the grade is what actually drives the recovery timeline, not just how much it hurts in the moment.
Grade 1 and 2 injuries typically improve over a couple of weeks with the right care. Grade 3 injuries can take months, and some need imaging or a referral to rule out a complete tear that needs surgical repair.
- Grade 1 (mild): the tissue is stretched, with little to no tearing. Usually sore but stable.
- Grade 2 (moderate): a partial tear. Expect more swelling, some bruising, and a noticeable loss of strength or motion.
- Grade 3 (severe): a complete tear. Often a pop at the time of injury, significant swelling, and the joint or muscle may not bear weight or function normally.
The First Few Days: Why Ice It and Rest Is Not the Whole Story
Most people still default to the old advice: ice it, wrap it, stay off it, and wait. That is not wrong exactly, but sports medicine has shifted toward getting the area moving again sooner rather than later, since prolonged rest and constant icing can actually slow down the tissue's own repair process.
In the first day or two, the priority is protecting the area from further damage. After that early window, the focus flips to gently loading the area again and getting some pain free movement going, rather than sitting still and waiting for it to feel better on its own.
- Protect: limit movement that aggravates it for the first day or two
- Elevate: keep the area raised above heart level when you can
- Avoid: go easy on anti-inflammatory medication and heavy icing early on, since inflammation is part of how the tissue repairs itself
- Compress: light compression with a wrap can help control swelling
- Then: reintroduce movement, get some pain free blood flow going, and add in targeted exercise as it improves
Overuse Injuries Do Not Show Up Overnight
A rolled ankle or a pulled hamstring happens in a single moment. Overuse injuries build slowly, from the same motion repeated over and over without enough recovery in between, which is why they are easy to shrug off until they are not.
It usually starts as a dull ache during practice that fades once you stop. Over time, that same ache shows up earlier in the session, lasts longer afterward, and eventually sticks around even at rest. Morning stiffness, a slight limp or favoring one side, or losing part of your range of motion in a shoulder, elbow, or knee are all signs the tissue is under more stress than it can recover from between sessions.
- A dull ache that starts during activity and fades afterward
- Pain that shows up earlier each session or lingers longer afterward
- Morning stiffness, especially around a tendon
- A slight limp, favoring one side, or losing part of your normal range of motion
How We Evaluate and Treat a Sports Injury
When an athlete comes in with a strain, sprain, or overuse injury, we start with a straightforward exam, and use digital X-rays and postural analysis when we need a clearer picture of what is actually going on rather than guessing.
From there, treatment is built around what the injury actually needs. Chiropractic adjustment addresses joint restrictions that often show up alongside a sprain or strain, especially once the body starts compensating around the injured area. Physiotherapy uses targeted exercises to rebuild strength, motion, and control. For inflammation and tissue repair, Class IV laser therapy is a non-invasive option we use to support pain reduction and circulation without adding another medication into the mix.
The goal is not just getting the pain to go away. It is making sure the area is actually strong and stable enough that you do not end up right back here in three weeks.
Getting Back to Your Sport Without Getting Hurt Again
The biggest driver of repeat injuries usually is not bad luck, it is going back too soon. Research on return to play consistently points to the same markers: being pain free through full range of motion, and having strength in the injured area that is close to matching the uninjured side, rather than picking an arbitrary number of days and hoping for the best.
In practice, that means easing back in rather than jumping straight from the sideline into full competition. Start with the movements your sport demands at a lower intensity in a controlled setting, and only add speed, contact, or full effort once those movements feel completely normal, not just tolerable.
- Full, pain free range of motion in the injured area
- Strength close to matching the uninjured side
- Sport specific movement, like cutting, jumping, or throwing, without pain or hesitation
- A gradual step back into practice intensity before full competition
Why This Is Personal for Dr. Johns
Dr. Johns played football and competed in weightlifting and track through high school and college, and it was actually a football injury that first introduced him to chiropractic care and steered him into the field. That background carried into his clinical experience working with professional athletes across the NFL, NHL, MLB, ATP, and AMA.
That is the lens sports injuries get treated through here: not just making the pain go away, but understanding what it actually takes for an athlete to trust their body again and get back to competing.
FAQ
Frequently asked questions
What is the difference between a sprain and a strain?+
A sprain is an injury to a ligament, the tissue connecting bone to bone at a joint. A strain is an injury to a muscle or tendon, the tissue connecting muscle to bone. Both get graded the same way, from a mild stretch to a complete tear, and the treatment approach depends more on the grade than which one it technically is.
Is it still okay to ice a sprain or strain right after it happens?+
Ice can still take the edge off pain in the first day or so, but the bigger shift in current guidance is away from treating rest and ice as the whole plan. Inflammation is part of how the body repairs tissue, so the modern approach favors protecting the area briefly, then reintroducing gentle movement early instead of staying still for a week and hoping it heals on its own.
How do I know if nagging pain is turning into an overuse injury?+
Watch for pain that shows up in the same spot every time you play, stiffness the next morning, or pain that sticks around even after you stop the activity. A single sore muscle after a hard practice is normal. Pain that keeps returning in the same place and slowly gets worse over weeks is usually the pattern of an overuse injury forming.
When can I get back to my sport after a strain or sprain?+
There is no single number of days that applies to everyone. The better markers are whether the area moves through its full range of motion without pain, whether strength on the injured side is close to matching the other side, and whether you can do sport specific movements like cutting, jumping, or throwing without pain or hesitation. Going back before those are true is the most common reason athletes reinjure the same spot.
Can chiropractic care actually help with a sports injury, or is that just for back pain?+
At North River we see plenty of sprains, strains, and overuse injuries that have nothing to do with a bad back. Dr. Johns played football and competed in weightlifting and track through college, and has worked clinically with professional athletes across the NFL, NHL, MLB, ATP, and AMA, so evaluating and treating sports injuries is a regular part of the practice, not an add-on.
Do I need an X-ray before starting treatment for a sports injury?+
Not always, but if there is a chance of a fracture, or if the injury is not behaving the way a typical sprain or strain should, digital X-rays and postural analysis help rule out anything more serious before building a treatment plan.
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