Treat Strains & Sprains

1. .   .   Initial damage and immediate treatment.

Also on this page

2.   .   . Contrast Bathing to heal Inflammation internally       For Sports Injuries- Get a week’s healing every day – This system is that good, simply repeat six times and you will have a whole week’s healing in one day!

3.   .   .   Feel the Pain it’s good for you.. Using Pain Killers.

4.   .   .   Support.

Where muscle fibres are torn the damaged tissues ‘leak’ histamine and this chemical draws fluid to it then slightly thickens it to stop the joint moving and stabilise the fluid in the area. This is the typical puffy oedema one sees round a twisted ankle, wrist etc. this is a pretty effective splint supporting the damaged tissues. At the same time the remaining undamaged muscle fibres in the area go into spasm again to protect the damaged tissues and prevent us from overloading them and thus further damaging them.

So as a Therapist the first thing we do is drain the fluid and remove the spasm. This encourages the flow of fluids in the damaged tissues and allows them to heal faster. However since the patient is in less pain and being highly motivated to do their job they may ignore gentle advice to take it easy for a while. So we must be firm, the patient must not do further damage by heavy or prolonged use.


Initial damage and immediate treatment.

We have all seen inflammation where skin has been rubbed raw and is a bright red and weeping just after we fell over and skidded across the playground on our forearms. The tissues were red and sore with scratches and abrasions.

The first fluid to seep out was a clear bubble which later became suffused with blood and then the whole area started bleeding. It certainly stung like mad and picking the bits of gravel out of the wound was horrid.

That first fluid to emerge was clear, that was lymph and then the wound went through a stage of being very sticky, and then with the mixing of oxygen from the air the blood set and became a clot over the wound.

Inflammation internally is very similar but without the grit and only very limited supplies of oxygen.

The tissues are all red and weepy with lymph and blood mixing and this may sometimes be apparent under the skin as bruising. If it’s a bad bruise with a reddish centre that is arterial blood carrying oxygen surrounded by the dark blue part being venous blood without oxygen and then the yellowish lymph on the outside. The pressure within this area being what gives it that distinctive tenderness of bruising.

Should it not be visible under the skin then it has probably not bled or is so deep that the little bleeding is not visible and is not causing the distinctive tenderness of the pressure from a bruise.

Internal inflammation has several causes. Pressure, friction, persistent loading, a single overload and external trauma (a blow).

Initially there may be only inflammation and a small amount of fluid but if the pain from this is ignored [or not felt] then on exercise as the muscle warms the pain will disappear, but the friction of movement within the tissues literally rubbing the raw parts together will aggravate the inflammation and so pain will return with greater severity later.

The usual treatment is RICE

R est:               I ce:          C ompression :           E levation:

Rest to allow healing without further aggravating the injury.

Ice packs . This can be as frequent as every two hours for ten to fifteen minutes at a time at first. Being careful not to ice burn the skin by wrapping the ice or by placing it in a little water and checking it is not sticking to the skin regularly. Always Re-warm tissues after treatment.

Compression to reduce swelling .

Elevation to reduce the supply of blood.

After thirty six hours switch from ice to contrast bathing.

My preferred treatment is initial rest and elevation for the same reasons as above but with the application of witch hazel as soon as is practically possible after the injury. This will stop internal bleeding within minutes of application so reducing bruising. This obviates the need for compression so next comes the ice but only for a day then switch to contrast bathing two or three time a day at first. Inflammation will always be present where pain has been after the pain has gone.

Always Re-warm the tissues after treatment.


Contrast Bathing

Contrast bathing will speed the healing, but only speed it not reduce the pain. Again the patient needs to realise all of this, so direct them to these pages.

To Warm and cool various methods are popular, showers work well, so do warm and cool water bottles or flannels & towels or just bowels of water; gel packs are also good but because they take so long to cool after use you need a lot in the fridge for the cool where warming them can be done quickly in a microwave, even wheat bags for the hot and pollytheen bags full of cold water work for the cool.

Combinations can work well too. For instance if you are warming a shoulder in the shower you really don’t want cold water all down the rest of your body when it comes to the cooling bit. A cold wet towel applied just to the shoulder is much more acceptable.

Apply cold, not freezing, to an area to constrict the blood vessels and pump the blood away. Tissues and lymphatic vessels will also constrict taking toxins away. The shrinking that the cold induces in all the tissues literally forces the fluids out of the area. So you need to really cool the area which will take time and be uncomfortable but should not be painful. If it is, stop.tissues121

Apply heat [warmth not red hot] to the area to warm it through and induce dilation in the blood and lymph vessels thus introducing fresh blood into the area and with it all the nutrients that are needed to help the tissues heal and the resultant dilation of the soft tissues will flood both the soft tissues and the lymphatic system plumping it all up ready for the next bout of cold.

Warm for half the time that you cool, the idea is to cool the area not freeze it. 1 minute warm & 2 minutes cool is about right. The exception to this is when the damage is deep within a joint such as the shoulder or the knee when at least doubling the time periods may be needed to obtain the shrinking and plumping up of the tissues at the required depth, [slow contrast bathing].

Always End with warm as cold tissues are prone to damage if stretched undoing all the good in an instant should you slip. This is such a beneficial treatment that each ten minutes will roughly equate to a day’s normal healing.

So three ten minute treatments a day equates to four days healing in a single day. Now you know how it is that professional sportsmen and women can be returned to fitness so quickly.

The image I like of this is that of a little localised pump, pumping in the goodness and pumping out the badness. Simplistic but not that inaccurate.

I have had a patient with a quite badly torn muscle who, having tried contrast bathing for a couple of days and been convinced of the efficacy of it, then spent a whole day in the shower going from hot to cold and back again and from being unable to sit or stand straight on Friday evening was doing a full days physical work on the Monday.

This I would expect to lead to problems at some time in the future though he seems fine at present.


Using Pain Killers

Or
Feel the pain it’s good for you.

Taking pain killers is a really good idea when you are in pain and wanting to rest or sleep as the reduction in the level of pain will allow better rest and deeper sleep improving the quality of the healing and speeding up that healing.

However taking pain killers to go to work, be that hard physical labour like housework, digging the garden, farming or building or more gentle tasks like computing, washing up, or telephoning masks the pain and allows us to work on through and to do real irreversible damage. Were we able to feel that pain we would know it was long gone time to stop. PILLS2BMP

It is a really bad idea to take pain killers to permit even light work, let alone play Tennis, Golf or even snooker

When we take pain killers we stop feeling the true level of pain and, especially when we are physically doing, we can go on damaging tissues beyond all reason, to inflict real harm where there was only mild damage. Increasing healing times from a matter of weeks to months or years, if ever.

Even in relatively sedentary jobs like computing we may be concentrating so hard that with pain killers the level of pain that is being ignored as we stay almost still can be doing serious harm before we become so uncomfortable that we move about and give it relief.

Personally I normally prefer locally applied gels, lotions and sprays that penetrate the skin and relieve the pain where the cause is, rather than taking them orally, where from the stomach they enter the blood stream and circulate to where they are needed. With local application any adverse reaction will be noticed on the skin but with oral administration the lining of the stomach may be becoming seriously inflamed before the analgesic (painkilling) effect is overcome and the nervous system starts to report the problem strongly enough for us to become aware of it.

Anti-inflammatories can be pain killers because their effect of reducing inflammation does also reduce the pain.

Ibuprofen products work for men as both anti-inflammatories and as analgesics (painkillers) but for women they have little or no analgesic (painkilling) effect directly except as they are anti-inflammatories. For women they reduce the inflammation and so can reduce pain indirectly.

Aspirin and Paracetamol based products both work as analgesics and anti-inflammatories for both men and women.

The discovery of this has enforced a reassessment of how women feel pain. Childbirth holds the clue, women’s pain tolerance in the last three months of pregnancy rises phenomenally. As a result of this realisation there will in due course be a whole new range of painkillers based on hormones, that will work for both men and women.

The relevance is that women can take Ibuprofen products and go on to work, but for men there is no anti inflammatory that is not also an analgesic, so they must go to work without anything in the system.


Support

Should damaged muscles be given support? The quick answer is, at times.

You can take a Royal Marine to the northern most point of Dartmoor and run him with a fifty pound pack on his back to the southernmost point and he will probably get there before you can drive round on the dual carriageways. Take off his boots and give him his shoes and walk him into Plymouth and he will be fine but his predecessors spent so long in their boots that most of them would not have made it. Once they discovered this flaw in their training the Marines started training in their trainers as well as their boots.

So too much support is bad and too little is unhelpful. Watch the weight lifters they sit around in their support belts but, as they step on stage, they tighten their belts. Having lifted the weight they loosen the belt as they step off stage.

This is also how you should use support, so a golf player with torn back muscles might tighten their support belt before they drive off the tee but loosen it as they walk off down the fairway, enjoying the extra warmth for the damaged tissues. No support for chipping or putting but tightening it up again for the next drive.

Later sitting at their computer no support should be used so that when those damaged muscles start tightening and need some relief from movement, the patient is aware of it, gets up and moves around.

There is a problem with treating any injury and that is we are altering the body’s natural response to the problem which may be an over reaction but it is erring on the side of caution, change that and caution then has to be exercised by the patient. The question is will they do it or simply go ahead and do the things they wish to and re-injure it far more seriously.  As Therapists we must ensure that Patients understand this. 

So as he is leaving the Patient asked “Can I exercise now?”.  “Oh yes, gentle exercise will be fine, just gentle exercise” I said.  I’m old and fat my idea of gentle exercise is a walk to the shops and back. He is a young martial arts practitioner his idea of ‘gentle exercise’ turned out to be fifty star jumps followed by fifty squat thrusts and fifty, one arm push ups etc:.
Two hours later he is standing outside my door tipped to one side and in agony.