How to manage sprains and strains
DURING the current COVID-19 pandemic many people have been reluctant to attend healthcare facilities due to the risk of infection. The good news is that many minor injuries can be treated safely and effectively from home. Where possible, people should try to do so by following the guidance below but it is extremely important that you continue to seek medical advice and treatment promptly for more serious injuries and conditions.
An acute injury is a sudden injury of rapid onset usually associated with a traumatic event. Sprains and strains are the most commonly encountered acute injury in both amateur and professional sports as well as recreational activity.
A sprain occurs when one or more of your ligaments (strong bands of connective tissue that connect one bone to another) have been stretched or torn. This is usually as a result of excessive force such as from changing direction suddenly or falling or landing awkwardly. The knee and ankle are common locations for ligament sprains.
A strain, on the other hand, involves a stretch or tear of a muscle and its fibres. This usually occurs when the muscle has been overstretched or when it has been forced to contract (shorten) too quickly for example when accelerating or decelerating suddenly. Muscle strains are common in the lower limb (leg) musculature such as in the hamstring, quadricep and calf muscles.
While acute sprains and strains are most common in sports it should be remembered that the physical and psychological benefits of exercise far outweigh the risks! Almost anyone can get injured, whether it be someone who has increased their activity levels during the lockdown or an athlete returning to sports after an extended period of rest, sprains and strains can occur because the person’s body is simply not used to the physical stresses involved. Even experienced athletes can develop injuries due to overuse of specific muscle groups or because of the intensity of their training.
Some other risk factors for this type of injury include reduced conditioning (e.g. reduced flexibility or strength), inadequate warm-ups and cool downs, and fatigue due to inadequate rest and recovery. All of which are manageable and preventable!
So how do I know if I have a sprain or strain? Signs and symptoms of this type of injury may include pain or tenderness in the affected area, bruising in or below the affected area, swelling and/or a loss of normal function. The severity of the symptoms will depend on the extent of the injury with both sprains and strains graded in severity from grade 1 to 3, with 1 being the least severe and 3 being the most.
You should seek medical advice if you have any of the following signs or symptoms; severe pain, numbness, deformity of the injured area, an inability to weight bear, a feeling of the limb “giving way”, an inability to move the injured joint/muscle, or if the pain has not improved or gotten worse after four days of self-management.
If you think you have sustained a mild sprain or strain this can be managed effectively by following the PRICE protocol. This acronym stands for Protection, Relative Rest, Ice, Compression and Elevation which all focus on reducing pain and inflammation during the initial 72 hours post injury.
Protection
The aim of protection is to avoid further injury to the area. The type of protection required will depend on the location and type of injury. For lower limb injuries a crutch or brace might be necessary to protect injured area. Conversely, a sling or splint may be a good option for some upper limb injuries.
Relative Rest
Excessive movement of the injured area can cause increases in circulation and inflammation which can impede on the healing process. Avoiding excessive movement with relative rest allows the body’s natural healing process to take place. This does not, however, mean complete rest as this can this can slow down the recovery process in the long run! In general, a person should avoid activities that stress the injured area and cause pain but continue with gentle range of movement and isometric exercises that do not cause pain.
Ice
Ice or cryotherapy (cold therapy) is effective at reducing the pain, swelling and inflammation caused by an acute injury. The most common and convenient form of cryotherapy is an ice pack or plastic bag full of ice. To avoid ice burns this should not be placed directly on the skin but instead a paper towel or wet tea towel should be placed between the ice pack/bag and the skin. Cold exposure of between 10-15 minutes has been shown to be safer and more effective than longer periods of continuous ice application. This shorter cold exposure time should be repeated every 1 to 2 hours initially. It should be noted that some people are hypersensitive or even allergic to ice and therefore it is important that the ice pack/ bag is lifted and the skin checked for raised and blotchy areas of redness. If this is noticed the ice pack should be removed immediately and should not reapplied. Compression
This involves the use of a compression wrap such an elastic or crepe bandage. This external force reduces swelling and provides a mild support. The bandage should be tight enough to limit the swelling but not too tight as to cause symptoms such as numbness, tingling or colour changes. It should be applied directly onto the skin starting a few inches below the injury and wrapping in a figure of 8 or spiralling manner. The compression bandage should be removed at night to minimise complications that may go unnoticed when sleeping.
Elevation
Elevation is important in the initial phase post injury as it helps to reduce pain and decrease swelling. It is accomplished by positioning the injured area above the level of the heart. This can be done intermittently during the day, for example keeping the arm on a high armrest or resting the leg on a high chair in front of you when sitting. It can also be achieved at night by positing the injured limb on additional pillows when sleeping.
During this initial 72-hour timeframe after an acute injury you should also try to avoid heat such as hot packs or hot baths, massage and alcohol as these will increase the bleeding and swelling in the injured area, thus increasing inflammation and reducing healing.
It should be noted that following these guidelines alone will not solve your injury as it does not account for the loss of mobility, strength and balance that can often proceed a sprain or strain. A progressive exercise rehabilitation programme may be required to get you back to your pre-injury baseline.
The recovery and rehabilitation time will depend on the type and severity of the injury but your physiotherapist will be able to guide you on this. Usually it will begin with gentle pain-free range of movement, that avoids overstretching initially, and progresses to strengthening exercises that will help to rehabilitate the injured area and prevent a reoccurrence. In general, strengthening exercises should begin with isometrics which are contractions of the muscle without movement. This should then be progressed to concentric (muscle shortening) and/or eccentric (muscle lengthening) exercises initially in a non-weight bearing position (open chain) progressing to a weight bearing position (closed chain).
In some instances, other exercises such as proprioception exercises may need to be included to enhance joint positional sense, balance and reaction times which are particularly important after a ligament sprain. The final stage of rehabilitation will include other exercises such as fast ballistic movements, multi-directional movements and sports-specific activities.
If you require any further advice or guidance on acute, or indeed chronic, injury management contact Sligo Physiotherapy and Sports Medicine Clinic on 071 9150020 or visit sligophysiotherapy.ie or findaphysio.ie to find your local Chartered Physiotherapist. Reference: hse.ie