How to Handle an Acute Injury

The most common complaint of patients when they attend physiotherapy is pain.  Pain is something that everyone experiences sometime during their lifetime.  Some people more than others. However,  pain is such a broad subject so throughout the month of May we will be covering a series of topics with regards to pain management, the first one being acute pain and injuries. You might remember a similar post at the beginning of last year, but this information is just to valuable to not share with you again.

The term acute is often used to describe a type of injury (or illness) that is of rapid onset and progression but of a limited duration. These types of injuries are usually the result of a specific impact or traumatic event to the body.

Some examples of acute injuries:

  • twisted ankle
  • sprained or torn muscle or ligament
  • something as simple as bumping yourself.

Acute injuries often require immediate medical attention. It is important for you to know that when you have sustained an acute  injury, there are a couple of easy steps you need to take, to ensure your recovery time is as short as possible and that you’ll also be able to regain normal functionality. For these steps we take a look at first aid treatment with the P.R.I.C.E. regimen.

The PRICE regime is a simple 5 step protocol that even an untrained person can use to minimize the effects of immediate injury. The earlier the PRICE regime is adopted the better. The PRICE regime is a protocol that should be used immediately when an injury occurs and prior to being treated by Emergency Professionals or prior to receiving treatment from a Physiotherapist or Medical professional.

PROTECTION – When you get injured, Protect the area from further damage. Stop with what you are doing and take the weight off a knee or ankle injury.

REST – Allow an injury time to heal. Being brave and continuing with what you were doing, whether it is playing sport, or working in the garden is not wise. Ensure rehabilitation time to allow even a small injury to heal.
ICE – The best line of defense in most acute, soft tissue injuries is the application of ICE. Ice decreases swelling, bleeding, spasm, pain and inflammation and should be applied within the first 24-72 hours after injury. Here’s a brief review of the how, why and when of ICE therapy: (Do not apply ice directly on skin. Place a thin dish towel or old t-shirt over injured area.)

  • Why Ice and not Heat ?                                                           Swelling causes a lack of oxygen to local tissues which creates cellular damage. Ice decreases swelling and bleeding by causing a constriction of blood vessels; thereby, minimizing the damage. Pain is relieved directly by its effect on pain receptors and indirectly by a decrease in swelling.Heat increases blood flow to the specific area.  Now in an acute injury, we don’t want that.  Due to the injury, the body will automatically send more blood circulation to the injured area and inflammation will set in.It is only once the bleeding and swelling has subsided (usually within 72 hours), “heat”, in the form of hot packs, hot towels, hot baths and ultrasound, can play an important part in healing process and rehabilitation. Heat increases blood flow and the “stretch ability” of tissues, decreases pain, muscle spasm, and joint stiffness, as well as promotes soft tissue repair.
  • How long to Ice?                                                                                The amount of fat between the skin and the injured area and the depth of the injury determines how long you apply ice. Little fat? A minimum of 10 minutes will do. More fat? 20-30 minutes max. Brief applications until numbness is achieved are effective for conditions such as tendonitis, bursitis or ligament sprains. Longer durations are necessary for muscle strains. But be careful. Icing an area for too long can cause tissue damage.
  • How often?                                                                                            Two to three daily treatments for tendonitis-type conditions or superficial muscle-strains; however, the greater the amount of pain and/or muscle spasm, the more frequent the applications. Depending on the severity of the injury, ice can be applied every 1-1 1/2 hours.
  • When to use?                                                                             Immediately after an injury, up to 72 hours, and for relief of pain and swelling associated with exercise.

Remember, very cold products can induce hypothermia or cold burn so wrapping the ice in a cloth is advisable.

COMPRESSION – Compression of the swollen area will help to reduce the swelling. Any crepe or stretchy bandage will do.

For example, if you are hiking and you miss a step and sprain your ankle, and you are not close to your camp site  the best thing to do is to NOT take off your shoe…the shoe will give a form of compression and protection.  Otherwise if you take off your shoe, it will start swelling depending on the severity and you might not be able to get the shoe back on again. Then it is important as we said in the beginning to protect the ankle by not putting your full weight on the ankle.  Let the people who are with you help carry backpacks, etc.

ELEVATION – Elevating the injury to above the heart reduces the flow of blood to the area and reduces the swelling.

Remember, it is important to treat the injured area as soon as possible, and then in the case of sprains and muscle injuries, or even in the case of heavy bruising it is advised to see your physiotherapist for evaluation so that the necessary treatment can be started to keep the recovery time as little as possible so you can regain normal function. Please also note that if you had high impact trauma, it is advisable to have x-rays taken to eliminate the possibility of fractures. So go and see your medical practitioner asap if you are not sure about the extent of your injury.

Diaan Jooste is a registered physiotherapist in Nelson Mandela Bay. Her practice is in 339 Cape road, on the corner of fifth ave and cape road in Newton park. If you have any questions or would like to make her appointment, you can contact her at diaanjooste@yahoo.com

Tune into Kingfisher FM every Friday throughout the month of May between 11:00 and 11:30 to find out more about pain management with Diaan. www.kingfisherfm.co.za

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