Sprains and Strains

With springtime in full swing, most people awaken from hibernation and return to their favorite activities. Whether it's running, gardening or golf, this sudden resumption of movement often results in injuries. Many of these injuries are not serious, but significantly interfere with daily life. In today's blog, I will discuss some of the more common injuries that I see in my office and make recommendations on how you can treat them at home.

Ice, Heat or Both? 

This is an age-old question that I get asked on a daily basis and unfortunately there is no one correct answer. Applying ice to an injury helps slow down inflammation, so in an acute injury, ice can reduce swelling and pain. After 48 to 72 hours, the immediate inflammatory reaction diminishes and muscle tightness begins. Generally moist heat is most helpful at this time.

There are of course, exceptions. Immediately after exercise, it's often useful for athletes to use ice to treat nagging, chronic injuries. At the same time, moist heat can help when there is a sudden flare up of a chronic injury like back pain.

Ice is a simple treatment that is easy to get. A frozen bag of peas or freezing water in a Dixie cup works well. The only problem is that it melts. If you are out and away from where you can find ice, I recommend using instant cold packs  that can be taken anywhere.  

As far as heat options that are available, there are typically two categories: moist and dry. An example of moist heat would be a hot water bottle, while most electric heating pads provide dry heat. Since water conducts heat better than air, moist heat is generally more effective. Today, many electric heating pads do have a moist heat option.


Sprains and Strains

After an injury, many people are concerned about whether they have a broken bone. When the xray shows no signs of a fracture, they are often relieved. However recovery from sprains and strains can be as long or longer as a break and result in persistant disability. The reasoning for this is due to blood supply. When a sprain occurs, ligaments (fiberous tissues that connect bones together) are torn. Because the blood supply to ligaments is generally poor when compared to the blood supply of bones, the healing process is prolonged. Additionally, once a sprain occurs, unless it is rehabilitated properly, it will never be as strong as it once was.

This is why sprains and strains need as much care as a fracture. The initial treatment usually involves rest, ice, compression/stabilization and elevation. This is generally referred to by the mneumonic, R.I.C.E. Rest and ice are self-explanatory, but how do know what type of compression or stabilization device is best for your injury? I will discuss which devices you should seek out for some of the more common sprains and strains.

Ankle sprains - other than back injuries, ankle sprains are probably the most common injury that I see in my practice. Typically, either while running or even just walking, the ankle rolls inward and tears ligaments on the outer aspect of the ankle. Ankle sprains are graded on a scale of 1 to 3. The grade determines which ligaments are injuried and the prognosis for recovery. In order to initially stabilize the ankle, I generally recommend a "stirrup" ankle brace. This type of brace prevents any side to side movement of the ankle.


Once the swelling and bruising resolves after 2-3 weeks, it is now time to begin rehabilitating the ankle. Not only does mobility and strength need to be regained, but also proprioception- the ability to sense the position of your ankle and foot in order to maintain balance. To get mobility in the ankle, I generally recommend patients imagine that their big toe is a pencil and then spell out the alphabet with the toe. This brings the ankle through all the range of motions that are necessary to regain mobility.


Next, the ankle needs to be strengthened. Strengthening the muscles around the ankle can help make up for any weakening of the ligaments. Exercises can be performed in a variety of situations, whether you go to physical therapy or stay at home. The best way I find is to use an exercise band and do resistance activities. To use these bands, first tie it into a loop. Then put one end around a table leg and your ankle through the other end. By moving your ankle up, down and side to side against the resistance from the band, you can safely regain the strength in your ankle.

Retraining the ankle for proprioception is somewhat more of a challenge. Some therapist recommend placing your injuried ankle on top of a soccer ball and practice balance your foot (not both feet!). Another option is make or purchase a wobble board. Wobble boards are safer than a ball and allow the user to use both feet simultaneously to recapture proprioception.
 

Knee injuries - are another very common cause for visits to the doctor. Frequently, I will see someone who will tell me that their knee "gave out" or "locked up". This is often a sign that something more than simple sprain has occured. Not only do ligaments of the knee become damaged, but also the cartilage or meniscus can tear.These injuries to the knee can be more difficult to diagnose. Examination by a medical professional is often necessary to determine the extent of damage.

Aside from rest and ice, knee braces may be recommended by your provider. There is a large number of knee braces to choose from and they each work best in certain circumstances. For example, when a simple sprain of the knee cap or patella is diagnosed, an open neoprene sleeve is often the best choice. However, if there is more of a concern regarding injury to the hinge or collateral ligaments, a brace that has hinges on either side of the knee will provide better support.