Self-treatment of sprains and strains

By Philip Wagenaar
This item appears on page 75 of the May 2008 issue.

I pulled on the rope, whereupon the bucket promptly made the expected 180-degree tumble. A cascade of delightfully warm water washed over me. Feeling clean once again in the Kenyan bush, where we were on a hiking safari, I sat down on the rickety chair in the makeshift shower enclosure to dry my feet. As I bent over, one leg of the chair gave way and I landed on my right shoulder.

Excruciating pain and the inability to raise my arm suggested a rotator cuff tear. I didn’t think I had broken anything. Fortunately, the portable kitchen had some ice. After using it off and on during the day, the pain began to diminish.

Sound familiar? Many ITN readers have suffered strains or sprains while traveling by falling over a curb, hitting a stone, jumping off a boulder, lifting a suitcase, etc.

Sprain or strain

You probably wonder what the difference is between a sprain and a strain.

A sprain is a stretched or torn ligament, which is a band that connects bones and thereby supports joints. The injury may be the result of an accident, such as falling on an outstretched arm or twisting a knee. It is most commonly seen in the ankle or wrist.

Sprains are conveniently divided into mild, moderate and severe.

• In a mild sprain, which usually is caused by overstretching or slight tearing of one or more ligaments, the area is painful and tender without much swelling or bruising and, most important, there is no difficulty putting weight on the joint.

• In a moderate sprain, fibers in the ligament have torn but have not completely ruptured. Besides its being painful and tender, it is hard to move the joint. There is moderate swelling and the area may be black and blue. Weight bearing is difficult.

• In a severe sprain, a ligament is completely torn. In addition to pain, marked swelling and usually discoloration, there is the inability to move the joint. If in the lower extremity (knee or ankle), the leg will not support your weight. Unfortunately, you must consider the possibility of a fracture or dislocation.

A strain is a torn muscle or tendon (often called “a pulled muscle”). It frequently is caused by recent trauma from such activities as contact sports or from overstressing a muscle as in incorrectly lifting a heavy load. It is most commonly seen in the hamstrings or the back.

Strains show the same signs and symptoms as sprains, such as pain, limited motion, swelling and discoloration, muscle spasm and/or weakness. If you have a severe strain, the muscle is either completely torn or the tendon has ripped away from the bone.

In general, the greater the pain and swelling is, the more severe the injury.

Self-help measures

Since in many situations it may be inconvenient, nigh impossible, to visit a doctor, I would like to suggest some self-help measures, which you should use for 24 to 48 hours following an injury. These remedies can easily be remembered by the acronym RICE, which stands for Rest, Ice, Compression and Elevation.

1. Rest — Avoid activities that cause discomfort or swelling. Refrain from putting weight on the injured area for 48 hours. Crutches or a cane may help. Note that a cane should always be used on the uninjured side to relieve stress on the injured part. Use a sling or splint, where appropriate. Circumspectly exercise noninvolved muscles.

2. Ice — Immediately use ice on the area even if you are going to see a doctor, since cold applications reduce pain, swelling and inflammation and also may slow bleeding.

Use an ice pack for a maximum of 20 minutes (to avoid frostbite) every two to three hours for several days following the injury. Be careful if you have numbness of the skin, diabetes or vascular ailments.

You may be able to obtain ice at your hotel or a nearby kitchen (where, hopefully, you can fill a plastic bag with crushed ice or ice cubes) or you can buy a package of frozen food at a grocery store. (Best is a package, such as frozen peas, where the ice-cold vegetable is in direct contact with the cover of the bag.)

3. Compression — Compress the injured part with an elastic wrap (which you probably are carrying with your medical supplies). This immobilizes the involved part and prevents or diminishes the swelling.

Wrap the elastic bandage securely but not too snugly, starting at the end farthest away from your heart. You know the bandage is too tight if you experience increased pain and/or numbness or swelling.

4. Elevation — Elevate the injured area above the level of the heart (use a pillow or, if one is not available, stuff your clothes inside a pillowcase or bag) to help decrease the swelling.

Of course, the above self-treatment does not take the place of a proper evaluation by a health provider.

It also would be prudent to contact your emergency-medical-evacuation company, as it has physicians on call who can advise you of the best treatment.

Pain medication

You may want to take acetaminophen, which is generic Tylenol®, for pain relief. Overseas, many pharmacies are unfamiliar with the generic name “acetaminophen” or the brand name “Tylenol®” and know the drug only as “Paracetamol.”

Paracetamol comes in 500mg tablets. The usual adult dose is 2 tablets every 4 to 6 hours, not to exceed 8 tablets in 24 hours. Ingesting more can lead to kidney and liver damage, especially when associated with high alcohol intake.

Do not take acetaminophen for more than 10 days for pain or more than 3 days when you have a fever. As it is a major ingredient in numerous flu and pain medications, it is easy to ingest more than the safe dosage.

Continue the above treatment as long as you notice improvement. After a few days, start using the involved area judiciously, keeping discomfort as your guide.

Most mild sprains and strains get better in three to six weeks.

More information

For more information about sprains and strains and other related conditions, contact the National Institute of Arthritis & Musculoskeletal & Skin Diseases (NIAMS) Information Clearinghouse (National Institutes of Health, 1 AMS Circle, Bethesda, MD 20892-3675; phone 877/226-4267, fax 301/718-6366 or visit www. and type in the search box “Sprains and Strains”).