Treatment for the Common Sprain
By: Derrick Campbell, B.S. California State University Long Beach
Before we look into how to treat the injury we should first have an understanding of what is a ligament. Our skeletal system would not be able to maintain it’s structure without the integrity of our ligaments, which are the fibrous tissues that connect two bones or cartilages that holds together a joint. Being able to maintain the structural integrity of a joint while our body moves through various movement patterns is relied on the strength in our ligaments to provide the stability we need. Since our ligaments play such an important part of stabilizing every joint in the body, they are very much susceptible to injury due to overuse or when the joint is forced beyond its normal anatomical movement. This may result in the stretching or tearing of the ligaments, joint capsule, or both. There are three different degrees that we can classify the type of sprain in which the joint can sustain.
First-degree Sprain: The ligament is stretch with little or no tearing to the fibers. There is usually no abnormal motion produced when the joint is stressed and there is a firm end point at though it’s range of motion. What the athlete might feel is localized pain, mild point tenderness, and may have mild swelling to the joint capsule.
Second-degree Sprain: There is partial tearing of the ligament’s fibers and there maybe joint laxity when the ligament is stressed. The joint does have a soft end point when stressed. The athlete may feel moderate pain with swelling and a loss of function in the joint’s range of motion.
Third-degree Sprain: The ligament may have a complete rupture of it’s fibers which may cause gross laxity of the joint and possible instability with a definite loss of an end point feeling. Definite swelling is present and a complete loss of function of the joint.
For an athlete that is in training or in competition, it is common to have acute and/ or chronic injuries that may affect their performance at different levels. being able to quickly asses, treat and manage the injury does effect the amount of time the athlete will stay away from the sport. For most acute injuries the treatment would be the same is order to control the inflammatory stage and reduce the pain. What is recommended for a majority of sprains and/or strains is the “RICE” method which is an acronym for Rest, Ice, Compression, and Elevation. This is a simple method that delivers the best results for any type of acute sprain and/or strain.
REST: This can be from a few minutes up to 72 hours or even 3-4 months. The first 24-48 hours after the injury is considered a critical treatment period and gradually use the injured extremity as much as tolerated. Athletes must try to avoid activities that cause pain. Often using a splint, sling, or crutches is necessary to provide the adequate rest for the injured body part. this is all depending on the joint affected and the to which degree the joint was compromised. With rest, it allows the body to go through is natural heeling process and gives time for the swelling to decrease.
ICE: When icing the injury try to choose a cold pack, bag of crushed ice, ice massage with frozen water in paper cups or even with a bag of frozen vegetables (peas or corn) will do. For the first 48 hours post-injury ice for 20 minutes at a time, 4-8 times a day. Areas that have little fat and muscle, such as fingers or toes, the ice should only be applied for about ten minutes. The cold provides a short-term pain relief and also limits swelling by reducing blood flow to the injured area. To prevent any more damage to the tissues around the area, DO NOT ice the injury for more then 20 minutes at a time.
COMPRESSION: To help limit and reduce the swelling early in the treatment, compression with an ACE bandage wrap is the most affective. Some people do feel pain relief from the compression as well. The wrap should be laid on the injured area and should fit snug but not cutting off circulation to the extremity. If the athlete feels any throbbing or if digits become cold, blue, or tingle then re-wrap the area.
ELEVATION: To help with reducing the swelling, the injured area needs to be elevated at least 12 inches above the heart. Finding a comfortable position for the body is necessary in order to have the body part resting while icing. For example, if you injure an ankle, try lying on a bed or sofa with the injured foot propped up on one or two pillows.
Do all of the four parts of the RICE treatment together to decrease the healing time.
Anyone with Raynaud’s, diabetes, sensitivity to cold or any medical condition with reduced blood flow to the arms or legs should NOT use the RICE therapy. These people would need to see their provider for the care of any minor and/or more serious injuries.
After a day or two of treatment, many sprains, strains or other injuries will begin to heal. If there is still pain or swelling does not decrease after 48 hours of treatment, see a healthcare provider or go to the emergency room, depending on the severity of your symptoms.
Once the healing process has begun, light massage may help to reduce the formation of scare tissue and improve tissue response to healing. Some gentle passive stretching can begin once all the swelling has subsided. Trying to increase the range of motion of the injured joint or muscle willing increase the blood flow and promote healing. Be extremely careful not to force a stretch or take the extremity through the range of motion with increased speed. Once the injury moves out of the acute phase and the swelling and bleeding has stopped moist heat may be applied to help increase blood supply to the injury and promote healing. Finally, once the injury has healed, starting a strengthening and stability program will help reduced the risk of repeated trauma to the affected area.