Friday, July 20, 2012

Sprain vs. Strain and How to Treat Them Both

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.

Below, are all the details you will ever need to take care of MOST common joint and muscle injuries.  It is far better that you know rather than be ignorant to self-treating sprains and strains.

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.

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 mild, 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 fail at this. Remember the long list of questions? They’re all answered below.

1. Rest

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 neglect resting immediately, you 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 joints to stiffen up and muscles to waste away. That means you should avoid “babying” an injury as well.

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.

2. Ice

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.

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, leave the ice in place with a barrier.

You should ice for 15-20 minutes at a time. Though your injury may still hurt at the end of that time, further icing is ineffective. 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 fails to 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.

3. Compression

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 keep blood 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 can leave them on longer than ice though.) Even after you stop icing, you can continue to use compression for support. Compression bandages should never keep you inactive for too long. Remember to rest only as long as you need to.

4. Elevation

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.


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