Definition and Symptoms

Trauma to a joint (ankle, knee, back, wrist, etc.) with varying degrees of ligament injury or tearing, causing rapid swelling, pain, and discoloration.


Discussion

All sprained joints should be treated along the same lines. Most people think of ice application for a sprained ankle, but for some reason, the average person feels at a loss when other joints are sprained. We are always surprised to see how many people will put heat rather than ice on a sprained or severely strained back. A joint is a joint. Obviously, some joints cannot be easily treated with the standard RICE treatment (Rest, Ice, Compression, and Elevation), but ice and rest are the mainstays of such treatment and should always be employed.


Treatment

The general treatment for all sprains, where possible, is discussed below.

Rest

Do not use the affected joint from the first moment of injury for at least two days. If the ankle is involved, it should not bear any weight. Crutches are to be used when you must be upright, but avoid as much moving about as possible these first few days. Severe shoulder injuries require a sling to allow full rest. Severe back sprains require 24 to 48 hours of complete bed rest. Only after 24 to 48 hours, once pain and swelling has begun to subside, can you begin to mobilize the joint within the pain margin, taking care not to reinjure the joint.

Ice

Ice really should be the first item on the list, but ICRE is not so easily remembered. As soon as possible, hopefully within minutes, apply ice to the area. Swelling begins immediately, so it is essential to reduce this as rapidly as possible to minimize pain, reduce the possibility of adhesions, and speed healing. Apply ice over one layer of toweling to prevent burning the skin, or immerse the joint in ice water. Keep iced for 30 minutes. Ice is also used in the recovery period as long as there is any sign of inflammation.

Compression

To further prevent swelling, cover crushed ice with a plastic wrap and apply an adhesive bandage. Leave on 30 minutes, unwrap for 5 to 15 minutes, and rewrap. After the second ice compression wrap, apply a standard compression bandage, like an ACE bandage. Keep toes or extremities exposed so you can monitor for adequate circulation. If toes turn blue, unwrap and rewrap less tightly. This compression bandage may stay in place for a full 24 hours when the joint is checked, or it may be removed every 2 hours for an ice application.

Elevation

Elevate the injured joint to prevent effusion into joint and surrounding tissues. As healing progresses over the first 24 to 48 hours, and swelling and pain are reducing, the joint is now ready for mobilization. Place the joint in hot water or use a hot compress. Slowly move the area in all its normal movements to the point of pain, but not beyond. Some joints may require passive mobilization, in which the joint is taken through its movements manually, without the patient’s muscular assistance. Ice should still be used periodically throughout the day to speed healing and prevent the joint from swelling. If, for any reason, the joint swells after an activity, apply ice.

Physiotherapy

  • Interferential electrotherapy*: Apply electrotherapy 3 times the first week or two depending on the severity of the sprain.
  • Shortwave Diathermy*: Apply shortwave for 20 minutes 3 times per week for two weeks.
  • Ultrasound*: Use ultrasound applied under water 3 times per week for two weeks.
  • Alternate hot and ice-cold footbaths or compresses*: For an ankle or wrist, fill one container large enough to cover ankle or wrist with hot water and another with ice cold water (including ice cubes). Place the injured limb in the hot water for 3 minutes, then in the ice-cold water for 3 minutes. Repeat cycle three times, ending with the ice cold. You will find the ice cold bath is very painful for the first few days. If you cannot bear the whole 3 minutes in the ice cold, take your foot out when it gets unbearable, wait 15 seconds and then reimmerse. For joints that cannot be immersed, use hot and ice-cold compresses (reheating and re-cooling the compresses as needing). This therapy is the single most valuable part of your recovery so do not exclude it simply because it is painful. Do this alternate footbath twice daily until all pain is resolved.
  • Exercise*: It is essential for you to regain mobility as soon as possible. By day three, you need to begin to move your ankle slowly both passively and actively. With your hands, move your ankle slowly up and down, then side to side. Be careful to avoid reinjuring any torn ligaments. Using your muscles, do the same movements, also with extreme care. After a few more days you can begin to stretch the injured muscles. Fold a towel so that it is about three inches in width. Place this towel under the front third of your foot and very gently pull your foot toward your head (flexion). Only pull as far as your foot will go without pain. Do not be concerned if this movement is very limited. Now very gently push down against the resistance of the towel. Hold this effort for six seconds, stop pushing slowly, wait one-half second, and the pull on the towel so that the front half of the foot comes more into flexion. Repeat this cycle five times. Do this exercise twice daily. You also need to do the same type of stretch for inversion, eversion, and extension. For joints other than the ankle, apply the same gentle approach to exercises.

Therapeutic Agents

Vitamins, Minerals, and Others

Bromelain*: 2 to 3 tablets three to four times per day, taken only on an empty stomach This is the best anti-inflammatory medication available for soft tissue trauma.

Arnica tincture (topical)*: Apply four to six times per day.

Vitamin C and bioflavonoids*: 4 to 5 g at time of injury; 1 g per hour for first 2 to 3 days.

Homeopathic:

• Hypericum: 12, 30C, every 10 minutes until pain is managed.

• Arnica: 12, 30C. To minimize bruising, hourly for 6 hours, then 2 times daily for several days.

(Note: All severe sprains should be checked for fracture. If severe effusion into the joint has occurred, it may best be aspirated to prevent adhesions.)

Excerpts from Better Health Through Natural Healing 3rd Edition

First published in 1985, Better Health through Natural Healing has become one of the most successful and authoritative resources of its type, with more than 1.5 million copies sold worldwide. Since the original publication of this comprehensive guide, alternative therapies have become more and more accepted by the mainstream, and patients and practitioners of the wider medical community are embracing complementary medicine as an effective treatment option for a range of medical conditions.

The book is available at the West End clinic, exclusively in Australia.


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