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First Aid Refreshers, part 6: Sprains and Strains

February 14, 2012

First Aid, Frontier Medicine, Health

wilderness first aid: strains and sprains

It seems that at some point, just about everyone suffers from a soft tissue injury from either repetitive motion or maybe an accidental twist.  The first time I sprained an ankle was when I was five.  My younger sister had run off across a grocery store and I tore off after her (to tell her not to run, of course).  I took a shortcut and raced down an aisle that happened to have just been mopped.  Naturally I slipped, twisted my ankle, and then howled on the floor until my shame-faced mother came to collect me and my sister both.  I ended up in an Ace bandage on crutches for a couple of days.

Since that time, unfortunately I have determined that I am quite prone to tendinitis, so I have a bit of experience with this topic.

Defining the Problem

According to MedicineNet, a strain is an injury to muscle or tendon.  A sprain is an injury to ligaments.  They both hurt.

More about Strains

Our muscles are attached to our bones either directly or by means of a tendon.  When those fibers are overstretched, they can begin to pull apart, lessening their ability to contract well.  The severity of the injury to those fibers usually is determined by how much is of the tissue is damaged.  It is possible to tear the fibers completely.

More about Sprains

Our joints are kept in proper alignment and supported by ligaments.  These thick bands of tissue are what keep the joints bending in only the correct directions.  The ligaments are anchored directly to the bones.  Some joints have more than one set of ligaments holding them in place for motion in several directions (think about ball and socket joints, for example).

Any time the tissues are overused, forced to perform movements they are not accustomed to, or are pulled in directions they are not meant to go, damage may result.  Football players often tear their ACL in the knee (a grade 3 injury-  the most serious form of sprain) which may end their playing careers.

What body parts can be affected?

Though we most often think of knees, ankles, and maybe wrists, sprains and strains can happen all over the body.  “Whiplash” is essentially damage to the muscles and ligaments of the neck.  Fingers and thumbs can be  injured during falls or overused for a repeated motion.  Lower back pain is often the spasming of strained muscle fibers.  Even the core body muscles can be strained in extreme exertion or exercise.

What are the symptoms?

Sometimes, like in the case of a traumatic injury, we feel the discomfort immediately.  In other cases, particularly those resulting from repetitive motion (like maybe painting), it may be the next day before it begins.

Remember that pain is always an indicator that something is wrong.  In the case of a sprain or strain, it is a warning that the joint or tissues need rest and healing and protection from further injury.

In addition to pain, there may be swelling at the site of the injury.  There may be bruising evident too, but not always.  One of the body’s defense mechanisms is also stiffness in the affected area.  The swelling and stiffness are the body’s way of protecting the area by partial immobilization.  The muscles in the surrounding area may “knot up” or spasm to keep you from using it too much.  A limp or favoring the area may result.

When trying to diagnose a strain or sprain, it is important to check for broken bones also.  When an area is swollen, it is sometimes initially hard to tell.  If a bone is only fractured initially, but care is not taken to prevent further injury, a full break may result.

How do you treat sprains and strains?

The acronym used for remembering the treatment protocol is RICE.  This stands for Rest, Ice, Compression, Elevation.

Rest–  Stop the aggravating activity to prevent further damage.  This does not necessarily mean complete immobilization and lack of use.  The severity of the injury will determine that.  The patient can take cues from his own body about how to proceed.  If there is a great deal of pain associated with movement, more rest is needed.  It is common to have stiffness and tenderness after lack of use also, so sometimes gently easing back into activity will help.  Gradually increase the duration and intensity of movement according to the cues from the body.  Stretching the affected tissues gently should help also.

Ice– Cool the injured area.  This does not mean immersing the entire area in an ice bath since temperatures that cold for an extended period of time can be harmful to the skin or cause shock.  Rather, create an ice pack and slip it into a piece of cloth before applying it.  Alternately, immerse it in cool water.  Cooling the area sometimes helps lessen bruising too.

Compression–  This usually refers to the old stand-by, the Ace bandage.  In the case of a twisted ankle, for example, wrapping the injured part in a stretchy bandage may keep some of the swelling down while providing the support the joint needs to help in healing.  Be sure not to cut off effective circulation with a bandage wrapped too tightly.  If the parts beyond the bandage become cold or numb, loosen the bandage.

Elevation–  This is usually associated with swelling also.  The extremities, particularly legs, are often more prone to swelling by virtue of gravity.  Raising the affected part may help reduce swelling by pulling the excess fluid back toward the core of the body.

In most cases, OTC pain medication is fine for reducing the discomfort.  Just be sure not to overuse and further injure the tissues because the pain indicators are absent.

In severe strains and sprains where tendons or ligaments may be torn, there will be a limit to what you can do to truly heal them without a doctor.  Those kinds of injuries usually need surgery.  Over time, there may be some improvement with stretching and a gradual return to movement, but there may be some permanent loss of function.

One final note–  tendons are made of a different type of tissue than muscles.  They do not have as rich a blood supply.  As a result, they often take quite a while to fully heal.  When I have aggravated my tendons, it often takes 3 months to stop experiencing pain and stiffness in use.  Stretching helps, but the best thing I can do is just prevent injury by awareness of possible strain during activity.

My tendons rarely bother me while I am doing what aggravates them, only in the subsequent days.  It may take a little detective work to figure out the source of the irritation.  For example, for a while the tendons in the backs of my knees ached and I couldn’t figure out why.  Finally it dawned on me that when we moved a baby to the middle spot, I was having to overextend my tendons to reach his car seat.  When I began kneeling on the floor of the van, the pain eventually subsided.

At another time, I was having a lot of wrist pain.  When I began gripping the pull rope on the “chicken tractors” differently, my wrists eventually healed.

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