Acute Injury Mangement

How you can manage your injury before you attend Physiotherapy (and have better overall outcomes)

This month’s blog covers the initial management of traumatic injuries (regardless of the cause). Whether it be a sprained ankle from a game of footy or hurting your shoulder playing with the kids at home, these simple tips should help to get you through the time before you see your local GP or physio.

So what exactly happens when you sprain a joint or strain a muscle? Firstly let’s look at exactly what makes up a muscle or a ligament. The easiest way to think of a muscle is as a piece of rope. It may look like one solid piece however it is actually made up of a lot of little fibres all bunched together as you can see in figure 1. There are also nerves and tiny blood vessels that run through the muscle.

muscle structure Fig 1

Every day we put our bodies through exercises or activities that place forces through our muscles and more specifically through all those little fibres that make up the muscle. Normally these fibres all work together and easily manage the forces created by everyday activities. However sometimes due to the way we carry out an activity we can put an abnormal amount of stress through a muscle or ligament, thus resulting in an injury. One example of this would be when you roll your ankle while running. Normally as you run the sole of your foot strikes the ground and the resulting forces travels evenly through your foot and up the leg with no problems. However, when you roll your ankle a large majority of the weight travels through the outside of the foot. This places an abnormal amount of force through foot muscles and ligaments, which can cause stretching and possible tearing, (see Fig 2).

Lateral ligament sprainFig 2

This large force not only stretches and/or tears the muscle fibres but can also cause tears in the blood vessels within the muscle. If a tear occurs in a blood vessel, blood and certain chemicals can leak into the muscle. This release of blood and chemicals can cause inflammation in the surrounding muscle tissue and nerves, and thus cause you pain. With all traumatic injuries pain is your bodies’ way of trying to stop you from repeating a movement that is likely to increase the damage in the area.

At this stage you are likely to be feeling pain in the affected area even though you are not moving. This is what we refer to as “resting pain”, and it is an important sign as it lets us know that there is most likely some form of inflammation still occurring in this area.

The first step in your self-management should be to try to decrease this “resting pain”. By decreasing this bleeding and pain earlier it will allow your physiotherapist to not only better assess you but also allow them to begin your rehabilitation sooner.  Without this initial step your physio will be limited by what they can do, as most treatment techniques will likely irritate the affected area rather reduce your pain.

So what can you do?

It’s as easy as remembering the word RICE, which stands for

  • R est (relative)
  • I ce
  • C ompression
  • E levation

It may seem simple, but it is often the simple plans that work the best.

Relative rest is a phrase with many meanings depending on who you talk to. For me it means try to avoid movements or positions that will place stress on the affected part of the body. For instance try to avoid excessive walking and standing if you have an ankle injury or try to avoid heavy lifting if you injured your shoulder or arm. You know the saying, “no pain, no gain”, well it DOES NOT APPLY IN THIS SITUATION. Pain, (in an acute injury situation), is the body’s way of telling you that what you are doing is doing is causing more damage than good.

Ice is a good option in the initial 48-72 hrs following an injury to relieve pain. The ice helps to reduce bleeding in the affected area which helps to reduce swelling and inflammation and thus reduce pain. The most common way to apply ice is to place ice cubes in a zip lock bag with some water. The water helps the bag to conform better to your body. Wrap the ice bag in a towel and apply to affected area. NEVER place ice bag directly on the skin as this may cause an ice burn to the skin. Apply the ice for approximately 10-15 minutes but no longer, because if left on for too long it can cause frostbite-like changes in the tissue. After this time remove the ice and wait at least 45 minutes before icing the area again. Try to ice the area as many times as you can in the initial 48-72 hours after the injury.

Compression can be applied to joints such as the ankle or wrist using the basic crepe bandage found in a first aid kit. Compression helps to prevent fluid from building up in the joint, and in conjunction with elevation helps to reduce swelling and pressure thus reducing pain. Ensure the bandage is applied firmly, but does not restrict blood flow.

Finally we have elevation, which is exactly what it sounds like, elevating the affected area above the level of the heart. When part of the body is injured excessive fluid can be released in the affected area as an initial protective measure. As the body begins to heal it attempts to move this fluid, however usually there is more than it is able to move. By using gravity we can assist the body to return this fluid back to the heart were it can be redistributed around the body. It also helps to decrease the pressure in the affected area which can ease your pain.This advice is not just for those who injure themselves as a result of a traumatic movement or external blow to the body. This includes people suffering from a “flair up” of a previously diagnosed condition. HOWEVER you must always REMEMBER that if this advice causes your symptoms to get worse you should stop IMMEDIATELY. If the symptoms continue to build or worsen you should contact your GP or EMERGENCY services as soon as possible.

Alexander Murdock