Strains and Sprains

DEFINITION
Any joint in the body may be injured if the ligaments (fibrous bands that connect bone) are overstretched; in other words, if the joint is forced past its normal range of motion. (Strains refer to a stretching of a muscle or muscle tendon that can range from a small tear in muscle fiber to a complete separation of the muscle tendon.) Sprains refer to a stretching of the ligaments that connects bone to bone. Sprains can range from a first degree (indicated by a stretching of ligament) to a third degree (described as a complete separation). Specific treatment depends on the joint involved and the degree of injury. "Whiplash" neck injuries, jammed fingers, twisted knees and twisted ankles are usually sprains.

INITIAL CARE

• Rest is the first and most important part of care. Discontinue use of the injured joint immediately. Further immobilization by use of a splint or crutches may be recommended for a short period of time to prevent further injury.
• Ice application to the affected joint as soon as possible after injury occurs will reduce swelling and pain and minimize the inflammatory process. When cold is applied, it will deeply penetrate the soft tissue which will slow down the blood flow to the area, reducing swelling and causing numbing of the nerve endings. You will experience the following sequence of sensations - cold, stinging, burning and, finally, numbness. Although it is uncomfortable, it is important to tolerate the cold. Once the injured area becomes numb, the cold should be removed. Ice may be applied by placing an ice bag over the injured part or by gently massaging the area with ice. Treatment should consist of 20 minutes of "ice-on-cooling" followed by 90 minutes of "ice-off-warming" for at least twice a day during the first 72 hours for mild injuries. More severe injuries require more frequent ice applications during the first 72 hours.
• Compression will also help reduce swelling and is provided by wrapping the injured joint snugly with an ace wrap. The ace wrap should be worn during periods of activity - preferably following ice application and elevation. (The ace wrap should not be worn while sleeping). The bandage should be applied from the furthest point of the body and wrapped upward. An injured ankle should be wrapped from the toes toward the knee. An injured wrist should be wrapped from the fingers toward the elbow. An injured knee should be wrapped from the calf toward the thigh.
• Elevation of the injured part will help reduce pain, swelling and bruising by draining fluids from the swollen area. The injured part should be elevated during ice application and prior to applying compression. Proper elevation has the injured area placed higher than the heart. Elevate the body part every time you are seated.

RETURN TO NORMAL ACTIVITY
It is important to maintain normal mobility of the injured joint during the recovery phase. However, premature return to full activity may slow healing and lead to early re-injury. Undue stress or activity that causes pain should be avoided. Mild temporary discomfort during reconditioning exercise is not uncommon and of little concern. However, moderately severe or persistent pain is a sign that the level of activity is too advanced. The return to full activity should be done on a gradual basis.

FOLLOW-UP
Minor injuries may require no other treatment than this program. The length of time required for complete healing varies from person to person and with the severity of the injury. If the joint remains persistently tender or swollen, or if you have been instructed to do so, seek follow-up care or re-evaluation of your injury.

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