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Ouch - now what?

How to treat acute injuries
Most of us will know what it is like to have an acute injury. The sudden sharp pain in the calf muscle while walking, the slip into an unseen pot-hole that twists an ankle or the fall onto an outstretched hand that sprains a wrist. Now that we have the injury, what can we do to help it get better as fast as possible?

Injuries that involve an over-stretch or small tear to muscle fibres are called "Strains" and damage to the ligament fibres which support joints are called "Sprains". graphic Both of these injuries will damage the small blood vessels within muscles and ligaments.
Local bleeding into the surrounding tissues is responsible for the familiar signs of soft tissue injury: - heat, redness, pain and swelling. Knowing what to do to stop the bleeding as soon as possible will limit the extent of injury and promote recovery.
The correct early management of soft tissue injuries can easily be remembered as "PRICE":- Protect, Rest, Ice, Compress, Elevate.

These simple steps can help to ensure a speedy recovery but before embarking on any self-help measures first consider if your injury needs urgent professional help. If you have severe pain which does not subside, have immediate and profuse swelling, have extreme loss of function or otherwise think that the injury may be serious, contact your local Accident & Emergency department, doctor or Chartered Physiotherapist. For everything else start "PRICE".

First, "Protect" your injury from further damage. This can be as simple as avoiding positions which hurt or using a sling to support an injured wrist. Remember that the aim of treatment is to stop blood escaping from damaged vessels into surrounding tissues. Blood anywhere other than inside blood vessels is an incredible irritant and can damage healthy tissues. Do not apply heat to any soft tissue injury for the first 72 hours as heat can cause damaged tissues to continue to bleed.
Strong massage can prolong bleeding too and so should be avoided in the first three days.

"Rest" should be applied selectively in the first few days after injury. Resting the injured muscle or joint encourages any bleeding to stop. Rest in the first three days will also help protect the fragile fibrin bonds that are the first stage of tissue repair. Otherwise, move around as normally as possible - total rest is rarely required.

graphic "Ice" or cooling is used to limit soft tissue damage by reducing the temperature at the site of injury. This reduces blood flow to the injured area which will reduce both swelling and pain (and when injured we all want that!). However, ice is not for everyone and it needs to be applied with care so that injuries are not made worse.
If you have problems with your circulation, suffer with Raynauld's or just can't tolerate ice, don't use it. Research suggests that the best kind of cold to apply is crushed ice in a damp towel but a bag of frozen peas or a gel pack from the freezer are often more practical and are effective. Remember to wrap the ice in a damp towel to protect your skin from an ice burn.
An ice pack should be applied for 20 - 30 minutes but this will depend on the site of injury. If the area is very bony such as the elbow or has a poor blood supply such as the thick Achilles tendon at the heel, reduce the time to 10 -15 minutes. Ice can safely be applied every two to four hours to help control pain and swelling.

"Compression" seems to be the most important component of "PRICE". Compression will help control swelling which will reduce pain. Limiting the amount of swelling which forms after injury will also limit the overproduction of fibrin. This is the protein which will repair damaged tissues but too much fibrin will lead to a lot of unnecessary scar tissue.
Scar tissue causes muscles and ligaments to tighten up too much and that can slow recovery. Simple compression bandages such as Tubigrip (trade mark) or neoprene supports work well. Remember not to have the bandage too tight otherwise pins and needles will develop.

"Elevation" will help by lowering pressure on local blood vessels to limit bleeding in the injured area. This will reduce pain and swelling. If a limb can be maintained in elevation then don't apply compression at the same time. For this reason tubigrip should not be worn in bed at night.

The main principle underlying each aspect of "PRICE" is to limit bleeding from damaged tissues. This will help control pain and swelling. Controlling these will help you get better quickly but if you have any questions or doubts, consult your doctor or Chartered Physiotherapist.

This article was written by the McNaughton Physiogrange Team and first appeared in the April 2009 edition of 702 Gazette

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