When to See a Doctor:
Mild sprains and strains can be self-treated at home. But, you should see a doctor if you:
- Can't walk more than four steps without significant pain
- Can't move the affected joint
- Have numbness in any part of the injured area.
Tests and Diagnosis:
During the physical exam, Dr. Pisarek will check for swelling and points of tenderness in your affected limb. The location and intensity of your pain can help determine the extent and nature of the damage. Dr. Pisarek might also move your joints and limbs into a variety of positions, to help pinpoint which ligament, tendon or muscle has been injured.
X-rays can help rule out a fracture or other bone injury as the source of the problem. Ultrasound and magnetic resonance imaging (MRI) also may be used to help diagnose the extent of the injury.
Acute soft-tissue injuries vary in type and severity. Treating sprains and strains depends on the joint involved and the severity of the injury. When an acute sprain or strain injury occurs, the initial immediate self-care treatment is with the effective P.R.I.C.E. (see below) protocol approach, in most cases to minimize swelling (edema), etc. Try to rest the injured area for about 7 days.
Your physician may take an x-ray. If your injury is severe, your doctor may order other imaging tests, such as ultrasound or magnetic resonance imaging (MRI). Your injured limb may need to be wrapped in an elastic bandage or put in a soft cast. Your doctor may also refer you to a chiropractor, who will provide physiotherapy and rehabilitation by giving you exercises to help you strengthen muscles, joints, and ligaments.
1. The P.R.I.C.E. Protocol:
This protocol of initial self-care treatment incorporates five (5) simple rules to help speed recovery in the first 72 hours of a sprain (ligament) or strain (tendon, muscle) injury. In most cases beyond a minor strain or strain, you'll want your health care provider to help you with this process:
- P is for PROTECTION. Protect the injured area from sustaining any more damage.
- R is for REST. Avoid activities that cause pain, swelling or discomfort, but don't avoid all physical activity. Instead, give yourself relative rest, allowing the injury time to heal. Take a break from the activity that caused the injury. Your chiropractor may recommend that you use crutches to avoid putting weight on your leg. With an ankle sprain, you can usually still exercise other muscles to prevent deconditioning. For example, you could use an exercise bicycle, working both your arms and the uninjured leg while resting the injured ankle on a footrest peg. That way you still exercise three limbs and keep up your cardiovascular conditioning.
- I is for ICE. Even if you are seeking medical help, ice should be applied to an injured area as soon as possible. Use the 10/10/10 method of ice application: 10 minutes of an ice pack or slush bath of ice and water; followed by 10 minutes of rest without ice; followed by 10 minutes of ice again each time. Repeat every two to three hours while you're awake for the first few days following the injury. Do not apply ice directly to the skin. Cover the ice bag/ice pack by wrapping it in a moistened cloth or paper towel. Do not apply heat. Ice works to reduce pain and inflammation to your injured muscles, joints and connective tissues and may even slow bleeding if a tear has occurred. If the iced area turns white, stop treatment immediately. This could indicate frostbite. If you have vascular disease, diabetes or decreased sensation... talk with your doctor before applying ice.
- C is for COMPRESSION. Use a tensor bandage to wrap and compress the injured area until the swelling stops. When wrapping, begin at the end furthest away from the heart. Don't wrap it too tightly or you may hinder circulation. Loosen the wrap if the pain increases, the area becomes numb or swelling is occurring below the wrapped area. Remove the wrapped tensor bandage when going to sleep!
- E is for ELEVATION. If possible, to reduce swelling, raise the injured area above the level of your heart, especially at night, by putting a pillow under the injured area. This allows gravity to help reduce swelling.
After the first 48 hours, slowly and gently start to use the injured area again and continue icing for another day or so. You should see a gradual, progressive improvement in the joint's ability to support your weight or your ability to move without pain. Mild and moderate sprains usually heal in three to six weeks.
Some evidence suggests that applying ice and using non-steroidal anti-inflammatory drugs (NSAIDs) helps you heal faster. For more severe cases, wrap the affected area in an elastic bandage. You may need a cast to stabilize injuries.
A chiropractor (see below) can help you to maximize stability and strength of the injured joint or limb. If you are unsure of the severity of your injury, consult a chiropractor for an evaluation.
2. Non-Drug Therapy:
In cases of a mild or moderate sprain or strain, you should apply ice to the area (refer to P.R.I.C.E. protocol above) as soon as possible to minimize swelling, reduce pain, bleeding and inflammation. It may also reduce more damage to other parts of the joint. In cases of severe sprain or strain, your doctor may immobilize the area with an ankle/foot brace or splint. Chiropractic (see below) mobilizations and adjustments along with physiotherapy modalities (low-level laser therapy, interferential therapy, T.E.N.S., ultrasound, etc.), kinesiology taping, stretching and strengthening exercises, custom orthotics, ankle/foot bracing or splints for stability may be utilized.
3. Chiropractic Care for Sprains and Strains:
While anti-inflammatory medications (NSAIDs) may be effective in increasing joint flexibility while reducing pain, researchers have found that chiropractic adjustments to the joints are just as effective. In fact, chiropractic treatment is even more effective in increasing joint mobility. You can get all the same improvements without the side-effects, such as liver or stomach damage, that occasionally comes with ingestion of NSAIDs.
Chiropractors may also recommend stretching and strengthening exercises to help you recover. One study found that a balance training (proprioception) program reduced the risk of ankle sprains among high school soccer and basketball players.
In a study of people with ankle sprains, researchers compared chiropractic joint manipulation with an anti-inflammatory medication. They found that joint manipulation worked as well as the anti-inflammatory medication in improving pain and flexibility. It worked better than the medication in improving range of motion and without any side-effects.
What should you do if you experience a sprain or strain? Seeing Dr. Pisarek at Advanced Healthcare should be your first stop. Chiropractors use many treatments that may help you recover more quickly. Treatments utilized by Dr. Pisarek may include various combinations of:
- Active rehabilitation procedures;
- Mobilization techniques and adjustments to the joints;
- Ice or heat application;
- Electrical muscle stimulation (EMS);
- Low-level laser therapy;
- Interferential therapy (IFC);
- Transcutaneous electronic nerve stimulation (TENS);
- Kinesiology (KT) taping;
- Ankle/foot bracing or splinting for stability;
- Custom computerized foot orthotics;
- Nutritional supplementation;
- In-office and home stretching and strengthening exercises;
- Referral, if indicated, to our in-house registered massage therapist to help increase circulation and relieve spasms in surrounding soft tissues.
Those with less severe injuries may treat the soft tissue damage at home by resting and with ice compresses. However, even those who have mild injuries can benefit from chiropractic treatment. Once the sprain or strain has healed, our ultimate goal as chiropractors is to help restore and maintain overall optimal 'peak performance' health to your spine, joints, muscles and organ systems.
Acupuncture appears to help sprains and strains. One study of 20 people found that acupuncture improved feelings of soreness. Other studies show no benefit. Acupuncturists often apply moxibustion (a technique in which the herb 'mugwort' is burned over specific acupuncture points) in combination with needling... in order to strengthen or deepen the treatment for sprains and strains.
5. Drug Therapies:
For mild sprains and strains, physicians will likely recommend basic self-care measures with over-the-counter pain relievers (analgesics) and/or nonsteroidal anti-inflammatory drugs (NSAIDs): These medications consist of:
- NSAIDs -- Reduce pain, inflammation, and swelling. These drugs may increase the risk of bleeding, so do not take them if you take blood-thinning medication such as warfarin (Coumadin) or clopidogrel (Plavix);
- Aspirin -- Do not give aspirin to children under 18, due to the risk of Reyes syndrome, a potentially fatal condition;
- Naproxen (Aleve);
- Ibuprofen (Advil, Motrin);
- Pain-relief creams: Studies show that applying topical diclofenac diethylamine (DDEA) 2.3% gel twice daily helps relieve pain, improve function, and speeds up recovery time;
- Acetaminophen (Tylenol, others): Do not take more than the recommended dose of acetaminophen. High doses can lead to liver damage.
You should ask your doctor about the right dose for you. Do not use over-the-counter pain relievers for more than 2 weeks. Also, do not use pain relievers to mask the pain so you can keep using the injured area.
On July 9, 2015, the U.S. Food and Drug Administration (FDA) has strengthened an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) increase the chance of a heart attack or stroke often immediately after taking an initial dose, either of which can lead to death. Patients taking NSAIDs should seek medical attention immediately if they experience symptoms such as chest pain, shortness of breath or trouble breathing, weakness in one part or side of their body, or slurred speech.
In some cases, such as in the case of a torn ligament or ruptured muscle, surgery may be considered.
7. Complementary Therapies:
Some nutrients and herbs may help the body restore damaged tissue, reduce swelling, and provide pain relief.
Nutrition and Supplements:
- Vitamin C (250 to 500 mg, 2 times a day) and beta-carotene (50,000 IU per day for 5 days) -- The body uses vitamin C and beta-carotene to create connective tissue. They may also reduce pain. Vitamin C supplements may interact with other medications, including chemotherapy drugs, estrogen, warfarin (Coumadin), and others.
- Bromelain (250 mg, twice a day) -- This enzyme that comes from pineapples reduces inflammation and swelling. Bromelain may increase the risk of bleeding. So people who take anticoagulants (blood thinners) such as warfarin (Coumadin), clopidogrel (Plavix), and aspirin should not take bromelain without first talking to their doctors. People with stomach ulcers should avoid bromelain. If taken with antibiotics, bromelain may increase the levels of antibiotic in the body, which could be dangerous.
- Zinc (15 to 30 mg per day) -- May help wounds heal faster. Zinc may interfere with a number of antibiotics and with the chemotherapy drug cisplatin.
- Glucosamine and chondroitin -- These are popular supplements for osteoarthritis that may help rebuild connective tissue. Some researchers think they may also help wounds heal faster. Usual doses are: glucosamine, 1,500 per day; chondroitin, 800 to 1,200 mg per day, divided in 2 to 4 doses. They are often combined in one supplement. Glucosamine and chondroitin can increase the risk of bleeding, especially if you already take blood thinners, such as warfarin (Coumadin) or clopidogrel (Plavix). Glucosamine may interfere with medications used to treat cancer. Ask your doctor before taking glucosamine and chondroitin.
Herbs help strengthen and tone the body's systems. As with any therapy, you should work with your doctor before starting treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted. Herbs that may help are:
- Turmeric (Curcuma longa) -- For pain and inflammation. Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger. Turmeric may increase the risk of bleeding, so people who take anticoagulants (blood thinners), such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, should not take turmeric without first talking to their doctors. Do not take turmeric if you have gallstones or gallbladder issues.
- White willow (Salix alba) -- To relieve pain. Willow acts similarly to aspirin. Do not take white willow if you are also taking aspirin or blood-thinning medications. Do not take willow bark products if you are allergic to aspirin or salicylates. Willow should not be given to children under the age of 18. If you have kidney issues, speak to your doctor before taking white willow.
- Applied topically (to the skin), the active ingredient in horse chestnut (Aesculus hippocastanum), called aescin, may reduce tenderness and swelling. Apply a gel with 2% aescin to the affected area every 2 to 3 hours.
Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for sprains and strains based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual:
- Arnica (topical) -- This remedy is generally considered the first-choice homeopathic treatment for acute injury. It is applied topically, in addition to an appropriate internal remedy. You should not use arnica, however, if the skin has open cuts over the injured area.
- Arnica (internal) -- For injuries with swelling, bruising, and inflammation. You should switch to another appropriate remedy once swelling has subsided.
- Bryonia -- For swollen injuries that get worse with movement. This remedy is especially useful for chest, shoulder, and hamstring injuries. It is often used if Arnica or Rhus toxicodendron fail.
- Ledum -- For sprained ankles that feel cold or numb but improve with cold applications (such as ice) and worsen with warm applications.
- Rhus toxicodendron -- This remedy is used after the initial symptoms of an injury have improved (such as from using Arnica). For pain during initial movement that subsides with more movement. The affected area generally feels hot. This remedy is especially appropriate for lifting or overexertion injuries.
- Ruta -- For tendinitis, torn ligaments, and other injuries that feel hot to the touch. Ruta is very useful as a treatment for overexertion injuries, such as tennis elbow and runner's knee. Symptoms tend to be worse with initial movement, but continued motion does not bring relief.
- Traumeel -- a proprietary formula, for management of mild-to-moderate injuries. One study found that Traumeel was as effective as conventional medicines for reducing the pain and inflammation associated with injuries, such as sprains, strains, and contusions.
Injuries often occur when people suddenly increase the duration, intensity or frequency of their activities. Many soft-tissue injuries can be prevented through proper conditioning, training and equipment. Your chiropractor probably won't need to see you again unless your injury was severe or you have complications.
Other prevention tips include:
- Use proper equipment. Replace your athletic shoes as they wear out. Wear comfortable, loose-fitting clothes that let you move freely and are light enough to release body heat;
- Balanced fitness. Develop a balanced fitness program that incorporates cardiovascular exercise, flexibility and strength training. Add activities and new exercises cautiously. Whether you have been sedentary or are in good physical shape, do not try to take on too many activities at one time. It is best to add no more than one or two new activities per workout;
- Warm up. Warm up to prepare to exercise, even before stretching. Run in place for a few minutes, breathe slowly and deeply, or gently rehearse the motions of the exercise to follow. Warming up increases your heart and blood flow rates, body temperature and loosens up other muscles, tendons, ligaments and joints;
- Drink water. Drink enough water to prevent dehydration, heat exhaustion and heat stroke. Drink 1 pint of water 15 minutes before you start exercising and another pint after you cool down. Have a drink of water every 20 minutes or so while you exercise;
- Cool down. Make cooling down the final phase of your exercise routine. It should take twice as long as your warm up routine. Slow your motions and lessen the intensity of your movements for at least 10 minutes before you stop completely. This phase of a safe exercise program should conclude when your skin is dry and you have cooled down;
- Stretch. Begin stretches slowly and carefully until reaching a point of muscle tension. Hold each stretch for 15 to 20 seconds, then slowly and carefully release it. Inhale before each stretch and exhale as you release. Do each stretch only once. Never stretch to the point of pain, always maintain control and never bounce on a muscle that is fully stretched as this may lead to 'shearing' of muscle fibres;
- Rest. Schedule regular days off from vigorous exercise and rest when tired. Fatigue and pain are good reasons to not exercise;
- Avoid the "weekend warrior" syndrome. Try to get at least 30 minutes of moderate physical activity every day. If you are truly pressed for time, you can break it up into 10 to 15 minute chunks.
9. Lifestyle and Home Remedies:
Regular stretching and strengthening exercises for your sport, fitness or work activity as part of an overall physical conditioning program can help to minimize your risk of sprains and strains. Try to be in shape to play your sport; don't play your sport to get in shape. If you have a physically demanding occupation, regular conditioning can help prevent injuries there too.
You can protect your joints in the long term by working to strengthen and condition the muscles around the joint that has been injured. The best brace you can give yourself is your own "muscle brace." Ask Dr. Pisarek about appropriate conditioning and stability exercises. Also, use footwear that offers support and protection... including custom prescribed foot orthotics if indicated.
10. Special Considerations:
Once a muscle or tendon is injured, it is susceptible to injury again, especially if you return to full activity too soon. Sprains and strains are easy to prevent. Basic physical fitness and strength training with proper warm up and cool down reduce the stress to muscles and joints.
Whether an injury is acute or due to overuse, if you develop symptoms that persist,
contact Dr. Pisarek at Advanced Healthcare by clicking here.
Isn’t it time you tried chiropractic care for you and your family?
If you are experiencing any of the common symptoms sprains and strains,
please contact our office now to schedule an appointment.