Sprains and Strains can be a Pain (in the….Neck)!

Sprains and Strains in a Collapse Situation

Hey, you can bet that, when the you-know-what hits the fan, you’re gonna be working those flabby old muscles of yours more than you  ever have before.   You’re gonna come up against the inevitable sprain or strain, so you need to know a little about what to do to get back to your normal awesome and incredibly-efficient self!  Let’s talk a little about what to do when you twist that knee or get that crick in your back!  I was gonna talk about this last week but we ran out of time!

First, some anatomy.  Anatomy is the blueprint of your body, so let’s look at the drawings and check out the operating manual.

Anatomy and Medical Preparedness

A ligament is the fibrous tissue that connects one bone to another, oftentimes across a joint.  They’re the structures that give you support so that you can stand upright and handle the work that you need to do. A sprain is caused by the excessive stretching of a ligament when a joint is forced beyond its normal range of motion.  When the muscle in the area is torn as a result of the injury, it is referred to as a strain.  The fibrous connection of the muscle to the bone or joint is called a tendon. When the tear of the ligament or muscle is complete, it is called a rupture.  These injuries may be associated with some bleeding into the tissues, and bruises may be seen at the site of injury.  Swelling is frequently seen as well.  The most common areas affected for sprains are the wrist, ankle, foot, knee, and the fingers and toes.  Strains often involve the back muscles.
There is a simple way to remember how to treat these types of injuries:  R.I.C.E.S.  This stands for Rest, Ice, Compression, Elevation, and Stabilization. 
REST:  It is important to avoid further injury by not further testing the injured joint.  Stop whatever activity that led to the injury.  I remember, sometime in the last century, I was a pretty good rassler for my high school team.  I sprained my ankle during one season, but I was gung-ho and wasn’t going to stop just because of that!  So I spent the next three seasons with one lower leg shaved and taped up like a mummy!  Despite that, because I didn’t rest the sprain, I re-sprained the ankle almost every match!  I got so used to it that I just came to expect it and worked my way through it during the match. Even now, that ankle is wobbly, and the damage to the ligaments became permanent!  Rest is very important if you want these injuries to completely heal!  Don’t be a dope like I was!
ICE:  Cold therapy decreases both swelling and pain.  The earlier it is applied, the better effect it will have in speeding up the healing process.  If you’re in the wilderness, you might have to stick your ankle in a stream to get some cooling action, although there are cold packs that are commercially made.  Cold therapy should be performed several times a day for 30  minutes or so each time.   This is followed each time by applying…..
COMPRESSION:  A compression bandage (taping it up, in other words) is useful to decrease swelling and should be placed after each cold therapy.  This will also help provide support to the joint.  After applying some padding to the area, wrap an elastic “ACE” bandage, starting below the joint and working your way up beyond it.  The wrap should be tight, but not uncomfortably so.  Any tingling, increased pain or numbness tells you that the wrap is too tight, and should be loosened somewhat.  The compression bandage will be a good source of support, also.
ELEVATION:  Elevate the sprain above the level of the heart.  This will prevent swelling from  worsening at the site of the injury.  Swelling is caused by fluid that pools where the inflammation is, and likes to go with gravity.  By elevating the leg, that fluid (also called edema) will process itself back into your circulation and aid the healing process, or at least not impede it.  This would also work for swollen ankles due to chronic medical problems, like high blood pressure….
STABILIZATION:  Immobilizing the injury will prevent further damage.  This may be accomplished by the compression bandage alone, or may best be treated with a splint or a cast if the patient is unable to place any weight on, for instance, the ankle.  Splints may be commercially produced, such as the very useful SAM splint, or may be improvised with sticks and cloth or duct tape.  Make sure the injured joint is immobile after placement of the splint. 
Strains, especially back strains, involve injury to the muscle and their tendons (which connects them to the bone).  As the lower part of the back holds the majority of the body’s weight, you can expect the most trouble here.  Some of these injuries are preventable with some simple precautions.
Every morning, you should perform some stretching, to increase blood flow to cold, stiff muscles and joints.  This is the reason that some people believe doing yoga is a healthy start to the day, or runners do stretching exercises before a race.  An ounce of prevention is worth a pound of cure!  If I had a nickel for every time I said that, I’d be rich!  When you lift a heavy object, such as a backpack, keep your back straight and let your legs perform the work.  The object should be close to your body as you lift it. (don’t reach for it and lift, you’ll be off balance and that’s the cause of a lot of muscle, ligament and tendon injuries).  For packs, keep the weight on the hips rather than the shoulders.  Hip belts are a must if you lugging a heavy load.  If you are on rocky or unstable terrain, consider using a walking stick for balance.  Now, medicines….
Ibuprofen is an excellent anti-inflammatory and pain reliever for these types of injury.  For muscle injuries, prescription relaxants such as Valium or Flexeril will also provide relief.  Natural remedies also help, the underbark of willow, aspen and poplar trees have Salicin, a natural pain medicine.

 If these are not available, the patient will benefit from mild massage and a heat pack.    In a normal situation, an X-ray or MRI of the affected part would be recommended to identify any hairline fractures or other hidden issues. In a disaster scenario, however, this may not be possible.  Some sprains and strains, (such as wrist and ankle sprains or back strains) commonly heal well over time with the above therapy and a lot of rest. Others, however, such as severe knee sprains with torn or ruptured ligaments, may heal completely only with the aid of surgical intervention!  Medical preparedness begins with you.  

Dr. Bones

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