Taking care of sprains and strains at home

With my oldest son starting practice in his first season of football, I decided writing a column on the treatment of sports injuries may be helpful for both older and younger athletes.  

Injuries are common in athletes and those that exercise regularly. Injuries can be discouraging because they limit the ability to continue athletic activity, and can even limit simple activities of daily living.

The following guidelines are meant to help your sprains and strains heal as quickly as possible, keep pain to a minimum, and help to identify more serious injuries.

Sprain, strain or worse?

Determining whether an injured joint is sprained or strained or if a bone has been broken can be difficult. Even subtle fractures are frequently more painful than sprains, but ligament tears can be excruciatingly painful. Determining the type and extent of an injury depends upon several factors including: how the injury occurred, how painful it is, and how bad the pain is 24 to 48 hours after the injury. You should seek medical advice if the joint cannot bear weight; there is numbness, deformity, severe pain or severe swelling; and if there is no improvement after several days.

If there is any question about the possibility of a broken bone or torn ligament, it is always best to get a medical assessment and find out for sure. X-rays show whether there is a broken bone, while an MRI or physical examination are better indicators of ligament tears.

Immediate treatment: RICE

So, let’s say that you have a sprained joint that is not a more serious injury. What is the best way to care for it?

 Immediately after the injury, cover the sprained joint with a thin cloth and apply crushed ice in a plastic bag. The standard recommendation is to apply ice for 20 minutes every two to three hours for 48 to 72 hours following the injury. According to a recent study published in the British Medical Journal, applying ice for 10 minutes on and 10 minutes off over the same 48 to 72 hours enhances pain relief, but is obviously more inconvenient.

Submersion of the sprained joint in ice water is more effective than a bag of ice or wet washcloth and is easy for ankles, fingers and wrists. Bathtubs and sinks can be used for submersion of larger joints like knees and elbows.

Remember that icing can be used as pain relief and is especially helpful before trying to fall asleep. However, it is possible to overdo it when icing an injury. Having a sprain and frostbite is worse than only having a sprain. Blue toes, fingers or skin are signs of too much ice; keep your skin pink!

The common acronym used in sprains is RICE (rest, ice, compression and elevation). Immediately after an injury, icing is most important. Let’s briefly cover the other components.

Rest the affected joint as much as possible. But moving it slightly by hand (without causing pain) will help reduce swelling and speed recovery.

Elevate the sprained joint 6 to 10 inches above the heart as much as possible during the first 48 to 72 hours and wrapped with an ace bandage to discourage swelling and encourage stability. If the joint is wrapped too tightly blood flow will be reduced — fingers and toes will turn blue.

Crutches and other devices such as gel pads and braces can help rest the joint as much as possible.

What about painkillers?

Painkillers, or non-steroidal anti-inflammatory (NSAIDs), are popular because they help to ease discomfort. The long-term benefit of painkillers for sprains and strains is debatable. Some studies point to slowed healing when painkillers are used. Another concern is that many painkillers have side effects that can contribute to other medical problems. Use these over-the-counter drugs cautiously.

After 72 hours: hydrotherapy

Once you’ve passed the 72-hour mark, contrast hydrotherapy is an excellent way to speed healing and improve function. Here’s what to do:

Set up two large bowls, one with hot water (as hot as you can take without causing a burn) and one with ice water.

Place a hand towel in each bowl

Apply a hot, wet hand towel to the affected areas for 3 to 6 minutes. Return the towel to the bowl with the hot water. Apply an ice cold hand towel to the affected areas for 30 to 60 seconds. Return the towel to the bowl with the ice water. Repeat this process three times consecutively. Repeat the entire process two to three times daily.

Using submersion instead of a wet wash cloth is more effective, but can be difficult for many joints.

When working on your recovery, activity is good; it encourages circulation and proper healing. Too much will set you back — your body will tell you if you’ve done too much, just listen to it.

And about nutrition...

If you read this column regularly, you probably know that I love promoting a healthy diet. Guess what? Eating lots of vegetables, fruits, whole grains, and lean meats will provide plenty of the nutrients needed to heal sprained or strained connective tissue. Eating good food is the best foundation for a rapid recovery and provides side benefits instead of side effects.

Richard Malik is a naturopathic doctor with a practice in Lakeville offering comprehensive health care for the entire family.