In his song “The Cape,” folk singer Guy Clark tells us about a young boy who, with a flour-sack cape draped around his neck, was sure he could fly off the garage roof. Trusting the cape didn’t work out so well. “He got a running start and bless his heart, he headed for the ground.”

We can imagine the scene that likely followed: The kid lands with a thud . . . and a very loud scream. Mom is quickly on the scene, sees him holding his ankle in agony, and asks the classic question: “Is it broken.”

Enough fantasy. But events a lot like that happen all the time in real life. On the basketball court. On a staircase. Wherever. And in most cases, it’s hard to tell how serious the injury is. Is it a fracture and or “just a sprain”? That last phrase is in quotes to call out the common misconception that a sprain is a lot less significant than a fracture. In fact, both injuries can be serious; both injuries need proper, sometimes intensive, treatment. But knowing which it is – a sprain or a break – isn’t an easy call for most of us. That’s why the smart move is a trip to the doctor to find out.

Yes, there are some signs that at least suggest whether you’re dealing with a sprain or a fracture, but first, let’s clarify the difference between the two injuries. A sprain is a stretch or tear of a ligament, the stretchy bands that hold the bones in place and help keep the joint stable. These bands are designed to move and stretch, but only to a point. A sprain occurs when they are stretched too far and, in severe cases, even torn. A fracture means that the bone is actually broken. But severity can vary greatly, from a micro-stress fracture that doesn’t even register on an X-ray, to a compound fracture where bone is protruding through the skin.

So how do you tell the difference short of a visit to the ER? Here are some hints:

  • Was there a noise when the injury occurred? A sprain is often silent, or in some cases you might hear a popping sound. If you hear a distinct crack, you can be pretty sure you’re dealing with a fracture.
  • Is the joint numb? A sprain is always accompanied with pain, often severe. A fracture may also be painful but if there’s numbness in the joint that’s another sign pointing toward a fracture.
  • Is the joint misshapen? Both a sprain and a fracture can cause swelling, but if the joint is also misshapen, the bone is most likely broken.
  • Where does it hurt when you touch it? Pain in the soft part of the joint suggests a sprain. If it hurts directly over the bone, it’s probably a break.

If you’re willing to trust your home diagnosis that you’re dealing with a fairly mild sprain, there are some steps you can take to improve your condition. Think R.I.C.E., the widely accepted protocol involving Rest, Ice, Compression and Elevation. Stay off of the joint. Apply ice packs (or a bag of frozen peas) right away to reduce inflammation. Use a pressure bandage to prevent or reduce swelling. And keep the joint elevated, higher than the level of your heart.

Though we’ve talked here about ankle injuries, just about any joint can fall victim to a sprain or fracture and the information you now have is applicable, whether you’re dealing with an injured wrist, elbow, thumb, whatever. One last piece of advice as you recover: be patient. Injuries like this take time to heal. In fact, some sprains can take longer than fractures, and once a joint has experienced a sprain, it’s more susceptible to re-injury. A fractured bone on the other hand can often return to its normal strength. So be careful – and patient – getting back on your feet.

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