Last month’s Super Bowl featured the usual media frenzy, but in the week leading up to the game, one story dominated the headlines.
How was Dwight Freeney’s ankle?
The Indianapolis Colts’ star defensive end had suffered a third-degree ankle sprain a week earlier. It was uncertain whether he would be able to play. The outcome of the NFL championship game — not to mention of millions of dollars in wagers — hinged on his health.
And so the biggest story in the biggest game of the year was one of the smallest parts of the body.
Injuries happen. They’re never any fun, and so we do whatever we can to make them go away as fast as possible.
Problem is, the things we do for them often make them worse. That’s particularly true of sprains and strains. It seems silly that something so common can be so tricky to treat. But that’s exactly why. Everyone thinks they already know how to do it.
They think they know how to do it, that is, until faced with questions like these: Should you use ice or heat? How long? How often? Should you use bandages? Braces? Walk it off? Stay off it? Put it up? Keep it down? And how do you get back to your normal routine?
That list would leave most people scratching their heads. Almost everyone has the basics down. But when it comes to treating sprains and strains, the devil is in the details.
In today’s article I will lay out all the details you’ll ever need to take care of most common joint and muscle injuries. Because the devil you know is far, far better than the devil you don’t.
Sprain vs. Strain: Some Definitions
Before we get too far into it, what’s the difference between a sprain and a strain, anyway?
Good question. A sprain is a ligament injury. Ligaments are the tough, fibrous tissues that connect bone to bone. They literally hold your joints together. When they are damaged, we call that a sprain.
In contrast, a strain is an injury to a muscle or tendon. You already know what muscles are. Tendons are the tough, fibrous tissues that connect muscle to bone. When either a muscle or a tendon is damaged, we call that a strain.
There are three different classifications for sprains and strains:
Grade 1. This kind of injury happens when the fiber (ligament, muscle, or tendon) is stretched a bit beyond its normal limits and sustains some minor damage.
Grade 2. This kind of sprain involves a partial tear of the fiber.
Grade 3. This kind of sprain involves a complete rupture or tear of the fiber. (A ruptured fiber remains intact but detaches from the bone.) Severe damage may require surgical repair.
Dwight Freeney’s injury, for instance, was a Grade 3 ankle sprain, the most serious kind. Fortunately, most injuries are not that severe. However, all sprains and strains recover best when treated immediately, so it is important to recognize them when they occur. You also need to be able to distinguish between those you can treat yourself and those that will need medical attention.
So what are you looking for?
Signs and Symptoms
The signs and symptoms of sprains and strains overlap significantly. (For the record, “signs” of an illness are directly observable or measurable. “Symptoms,” on the other hand, are subjectively reported by the patient.)
Common signs of a sprain include swelling, bruising, and decreased joint mobility. If the ligament ruptures, you may actually hear a “popping” sound. Symptoms of a sprain include pain and difficulty using the affected extremity.
The signs of a strain are very similar. They include discoloration and bruising. Generally strains are accompanied by less swelling than sprains, but that obviously depends more on the severity of the injury than on the type. Symptoms include local pain and stiffness.
If you suspect that you have suffered a sprain or a strain and you are experiencing severe pain or functional impairment, you should probably consult a doctor. These can be signs of a fracture or a complete tear. The doctor will use an X-ray to rule out a fracture. After the swelling has gone down, he or she may also order an MRI to check for a tear.
If, on the other hand, your injury is not severe, you can treat it yourself by remembering the following simple mnemonic.
The RICE Method
RICE stands for Rest, Ice, Compression, and Elevation. This method is taught to EMTs and orthopedists alike because it is the optimal form of treatment for most sprains and strains. Though it may sound like common sense, you need to make sure that you are doing each step correctly — and most people aren’t. Remember the long list of questions? They’re all answered below.
The biggest mistake that most people make with sprains or strains is to try to “walk them off.” That’s fine for cramps. For sprains and strains, however, additional force usually means additional injury. Nevertheless, many people will continue hobbling through their activities and then apply ice only much later that night, if at all.
That’s too late. The first 24-48 hours after an injury are when ice, compression, and elevation will make the most difference — the sooner, the better. If you don’t start resting immediately, not only do you run the risk of hurting yourself even worse, you also deprive yourself of the potential benefits of the rest of the RICE method.
The other mistake that people make is resting too much or too long after an injury. Prolonged immobilization causes joint to stiffen up and muscles to waste away. That means you can’t “baby” an injury, either.
Instead, you should rest only until you are pain-free — within one to three days for most injuries. Then try to ease back into your normal routine. Listen to your body. Stop if it hurts, but do as much as you can handle. Strength and flexibility fall into the use-it-or-lose-it category. Appropriate rest will speed your recovery.
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As funny as it may sound, most people also ice incorrectly. You should ice immediately after an injury to minimize swelling and ease pain. Swelling is the real enemy. Ice keeps swelling down because cold constricts blood vessels, which slows the arrival of inflammatory molecules. It also numbs the nerves at the site of injury to reduce pain.
Don’t wait. Ice right away.
You should never apply ice directly to the skin for an extended period of time. There are two better options. You can place a thin layer — a towel, for example — between the ice and your skin. Or you can perform an “ice massage.” To do that, just move the ice over the injured area as if you were rubbing it. Either way, don’t leave the ice in place without a barrier.
You also shouldn’t ice for more than 15-20 minutes at a time. Though your injury may still hurt at the end of that time, further icing won’t do any good. In fact, it may hurt: you run the risk of frostbite and other complications with overly long icing sessions. Instead, wait an hour or so. Then check the area again. If it has normal tactile sense and feels warm to the touch, you can ice it for another 15-20 minutes. You can then repeat that process as many times as you like. (Though it really doesn’t help after more than a day or two.)
The ideal ice pack is a Ziploc bag filled about three-quarters full with ice and a little bit of water. The water helps the ice pack conform to your body. You can also use packages of frozen vegetables.
For those who prefer hot to cold, heating does have its place. It is a great way to loosen up stiff muscles and joints. It relaxes tissues and stimulates blood flow. You can use heat before exercising (also for 15-20 minutes at a time), but you should never heat after an injury, as it will exacerbate swelling. (You should also never heat while you sleep.) A simple rule of thumb is to heat before, ice after.
The mistake that most people make with compression is one of omission. Compression helps to immobilize an injury and provide support. When combined with ice, it also helps to minimize swelling and pain.
To compress an injury, wrap an Ace bandage around the site. Try to overlap about half the width of the bandage on each pass until you completely cover the injury. You want it to be snug, but make sure that you don’t cut off circulation. If you start to get cold, blue, tingly, or numb, it’s too tight. Undo the bandage and rewrap it a bit looser.
You should use compression bandages at least as long as you are icing the injury. (You don’t have to take it off every 15-20 minutes, though.) Even after you stop icing, you can continue to use compression for support. Just don’t let the bandage keep you inactive for too long. Remember to rest only as long as you need to.
Finally, elevate the site of your injury above the level of your heart. Just like cold compression, elevation works to decrease swelling. Elevation also prevents fluid from pooling. Keep the injury elevated at least as long as you are icing it.
The RICE method is the most effective possible treatment for most sprains and strains. As you can see, all four steps work in concert to treat sprains and strains.
Many people also take nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling. They are effective for this purpose, and short-term use for an acute injury won’t likely have many side effects. However, if you’re hurting, you might also consider some of the natural alternatives to NSAIDs that I described last week .
Injuries happen, even to professional athletes and often at the most unfortunate times. The outcome of this year’s Super Bowl turned on Dwight Freeney’s ankle. But you don’t have to be a professional athlete to take advantage of this method. If you suffer a sprain or strain, just remember to rest, ice, compress, and elevate. You’ll be good as new in no time.
To Your Health,
Managing Editor Total Health Breakthroughs
P.S.: Now that you know how to treat sprains and strains, stay tuned for Tuesday’s issue, when we’ll discuss the best ways to prevent them from happening in the first place. You know what they say: an ounce of prevention is worth a pound of cure. And that’s a lot of rice!
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