By Richard Malik, ND
As published in the Lakeville Journal, Millerton News, & Winsted Journal
6 September 2007

With my oldest son starting practice in his first season of football, I decided writing a column on the treatment of sports injuries may be helpful for both older and younger athletes.

Injuries are common in athletes and those that exercise regularly. Injuries can be discouraging because they limit the ability to continue athletic activity or even limit simple activities of daily living.

The following guidelines are meant to help your sprains and strains heal as quickly as possible, keep pain to a minimum, and help to identify more serious injuries.

Determining whether an injured joint is sprained, strained, or if a bone has been broken can be difficult. Even subtle fractures are frequently more painful than sprains, but ligament tears can be excruciatingly painful. Determining the type and extent of an injury depends upon several factors including: how the injury occurred, how painful it is, and how bad the pain is 24-48 hours after the injury. You should seek medical advice if the joint cannot bear weight; there is numbness; deformity, severe pain; severe swelling; and no improvement after several days.

If there is any question about the possibility of a broken bone or torn ligament, it is always best to get a medical assessment and find out for sure. X-rays show if there is a broken bone while an MRI or physical examination are better indicators of ligament tears.

So, let’s say that you have a sprained joint that is not a more serious injury - what is the best way to care for it? Here are some of the most helpful suggestions.

Immediately after the injury cover the sprained joint with a thin cloth and apply crushed ice in a plastic bag. The standard recommendation is to apply ice for 20 minutes every 2-3 hours for 48-72 hours following the injury. According to a recent study published in the British Medical Journal, applying ice for 10 minutes on and 10 minutes off over the same 48-72 hours enhances pain relief,, but is obviously much more inconvenient.

Submersion of the sprained joint in ice water is more effective than a bag of ice or wet washcloth and is easy for ankles, fingers, and wrists. Bathtubs and sinks can be used for submersion of larger joints like knees and elbows.

Remember that icing can be used as pain relief and is especially helpful before trying to fall asleep. However, it is possible to overdo it when icing an injury. Having a sprain and frost-bite is worse than only having a sprain. Blue toes, fingers or skin is a sign of too much ice - keep your skin pink!

The common acronym used in sprains is RICE (Rest, Ice, Compression, and Elevation). Immediately after an injury, icing is most important. Let’s briefly cover the other components.

Rest the affected joint as much as possible. Moving it slightly by hand (without causing pain) will help reduce swelling and speed recovery.

Elevate the sprained joint 6-10 inches above the heart as much as possible during the first 48-72 hours and wrapped with an ace bandage to discourage swelling and encourage stability. If the joint is wrapped too tightly blood flow will be reduced - fingers and toes will turn blue. Crutches and other measures like gel pads and braces can help rest the joint as much as possible.

Painkillers, or non-steroidal anti-inflammatory (NSAIDs) are popular because they help to ease discomfort. The long-term benefit of painkillers for sprains and strains is debatable. Some studies point to slowed healing when painkillers are used. Another concern is that many painkillers have side effects that can contribute to other medical problems. Use these over-the-counter drugs cautiously.

Once you’ve passed the 72 hour mark, contrast hydrotherapy is an excellent way to speed healing and improve function. Here is what to do:

• Set up two large bowls - one with hot water (as hot as you can take without causing a burn) and one with ice water.
• Place a hand towel in each bowl
• Apply a hot, wet hand towel to affected areas for 3-6 minutes. Return the towel to the bowl with hot water
• Apply an ice cold hand towel to affected areas for 30-60 seconds. Return the towel to the bowl with the ice water
• Repeat this process 3 times, consecutively
• Repeat the entire process 2-3 times daily
• Using submersion instead of a wet wash cloth is more effective, but can be difficult for many joints.

When working on your recovery, activity is good; it encourages circulation and proper healing. Too much will set you back - your body will tell you if you’ve done too much, just listen to it.

If you read this column regularly, you probably know that I love promoting a healthy diet. Guess what! Eating lots of vegetables, fruits, whole grains, and lean meats will provide plenty of the nutrients needed to heal sprained or strained connective tissue. Eating good food is the best foundation for a rapid recovery and provides side benefits instead of side effects.