The summer sports season will be starting soon, as will gardening and other outdoor chores. If they haven’t already, weekend warriors will soon be doing all sorts of things to keep doctors who treat musculoskeletal injuries busy. I want to give everyone some pointers in how to take care of the inevitable sprains and strains.
It’s interesting to me how many people come to my office after suffering an injury and don’t have any idea how to do some initial first aid. It’s extremely important to treat injuries immediately to prevent additional damage and disability.
When a musculoskeletal structure is injured, a biochemical chain reaction is triggered to attempt to heal the injury. Injured cells release various messengers that start the process, but this also results in pain and swelling. The intent of this inflammation is to get the injured person to immobilize the area so it can heal. However, for an athlete or anyone trying to get back to play or work as soon as possible, this can prolong the time it takes to get back to normal function.
The goal of orthopedic and sports medicine is to promote healing of an injury, but to also speed up the recovery process. The best way to do this is to prevent or slow the normal inflammatory chain reaction. It’s very simple really. The only memory aid you have to recall when you are injured is the word “RICE.”
The “R” in RICE stands for Rest. If you have a strain or sprain, you should not continue to try and use the injured area. Many people get up and dust themselves off and continue on only to suffer additional injury or more severe problems later that evening or the next day. Everyone knows how stiff and sore an injured body part can be the day after it happens.
What’s the first thing you see athletic trainers and doctors do on TV when one of their athletes goes down? They apply ice, the “I” in RICE. Most people know to put ice on an injured area, but due to various reasons, often wait hours until they apply it. Therefore, it’s always advisable when away from home to have ice and plastic bags as well as a towel to treat injuries that might occur. Why the towel? You should never place ice directly on the skin – it can cause frostbite and also damage underlying nerves. There is no hard and fast rule about how long to apply the ice. I usually recommend twenty minutes on every couple of hours for the first day or two following the injury.
The “C” in RICE stands for Compression. You should apply something like an ACE bandage, neoprene sleeve or splint over the area to compress it and keep tissue fluid from accumulating. Swelling results in decreased blood flow to the area and delayed healing.
The “E” in RICE stands for Elevation. This goes along with Compression. When an injury is elevated, gravity helps prevent tissue fluid from accumulating. Typically, when we recommend elevation, we are talking about elevating the injured area a few inches above the level of the chest.
So, how long do you have to do RICE? I usually advise a minimum of 48 hours post-injury. At that point you have thwarted most of the body’s inflammatory reaction. After that initial 48 hours or sometimes even sooner, you can slowly start to move the injured area to work on regaining normal motion. Depending on the injury, you may also need formal instruction in rehabilitation. Musculoskeletal injuries often result in weakened muscles that need to be strengthened and re-trained to return to proper function and protect the involved area from additional injury.
Finally, in addition to RICE, taking a medication like ibuprofen or Aleve for a few days may be helpful in preventing inflammation. People with kidney or liver disease or who take blood thinners should speak to their physician before taking these medications.
Dr. John Roberts is a Crawfordsville physician. His column is published weekly in The Paper and he has a daily health tip as well. Dr. Roberts is one of the owners of Sagamore News Media, the parent company of The Paper of Montgomery County.