A sprain is an injury to a ligament. Ligaments are strong tissues around joints that attach the bone ends together. A ligament can be stretched during a sudden pull. This may partly tear some of the fibres in the ligament. Occasionally a ligament may fully tear (rupture). A damaged ligament causes inflammation, swelling and bleeding (bruising) around the affected joint. Movement of the joint is painful. The aims of treatment are to keep inflammation, swelling and pain to a minimum and to be able to use the joint normally again as quickly as possible.

Treatment of a sprain for the first 48 hours

Think of RICE - Rest, Ice, Compression, Elevation

• Rest - the affected joint for 48 hours after injury.

• Ice - should be applied as soon as possible after injury for 10-30 minutes. Less than 10 minutes has little effect. More than 30 minutes may damage the skin. An ice pack is made by wrapping ice cubes in a plastic bag. A bag of frozen peas is an alternative. Gentle pressure of the ice pack on the injured part may be more effective than ice just left next to the skin. The ice is thought to reduce blood flow to the damaged ligament which may limit pain and inflammation.

• Compression - with a bandage will limit swelling and help to rest a joint. A tubular compression bandage is used for most joints. Mild pressure that is not uncomfortable nor stops blood flow is ideal. A pharmacist will advise on the correct size.

• Elevation - will limit and reduce any swelling. For ankle and knee sprains, keep the foot up on a chair to at least hip level when sitting..Put the foot on a pillow when in bed. For hand or wrist sprains, use a sling with the hand and wrist higher than the elbow.

Treatment of a sprain 48 hours after injury and beyond

Movement should replace rest. It is important that the joint should begin to become active again. For most minor sprains this will simply mean starting to use it more freely. Don't do anything that causes too much pain but gently get the joint moving again. Sometimes it means doing gentle exercises several times a day to ensure the joint moves around in all normal directions and does not become stiff.. Sometimes a specific exercise programme is helpful for sports people or for people with severe sprains. However, it is best not to play sport or do vigorous exercise involving the sprained joint for 3-4 weeks after an injury.

Compression bandages should not normally be used after 48 hours. They limit the movement of the joint which should now be encouraged to move more freely.

Heat and massage may be soothing. These have the opposite effect on the blood flow than ice. That is, they encourage blood flow. This is beneficial for the healing process but should not be done within the first 24-48 hours after injury when inflammation is developing. Heat can be applied by using a hot water bottle, soaking in a warm bath or using a hot flannel or cloth.
Physiotherapy may be beneficial for more severe sprains or if symptoms are not settling. A physiotherapist may advise on exercises and give heat, ultrasound or other treatments.

Completely ruptured ligaments and other severe sprains may sometimes require surgery.

Medication for sprains

No medication may be needed if the sprain is mild.
Anti-inflammatory painkillers are useful to relieve pain and may also limit inflammation and swelling. Ibuprofen is available at pharmacies without a prescription. Others are available only on prescription. Some people cannot take these medicines. For example, people with duodenal ulcers and some people with asthma. An upset stomach is a side effect that sometimes occurs.
Paracetamol is an alternative. It is a good painkiller but does not reduce inflammation.

Seek further medical attention in the following circumstances:

• If there is a lot of tenderness over a bone

• If the pain is severe or if walking is impossible because of an injury.
  Bruising is severe.

• If symptoms and swelling do not gradually settle. Most sprains show signs of improvement after a few days and the pain eases. However, the pain may take several weeks to go completely, especially when using the damaged joint.

Preventing sprains

Always warm up before doing vigorous exercise. Ankle sprains are, by far, the most common sprain. Make sure good supporting footwear is used for sport. Avoid occasional bouts of vigorous exercise. Instead, aim for a general and steady build up to fitness.
 

Extract from Mentor Plus copyright OUP, EMIS and Authors 1999