Our joints are truly marvels of engineering.  They help provide mobility and locomotion and sometimes bear an incredible amount of stress without mishap.  They are moving parts, however, and moving parts can break down.  In long-term survival situations, our level of physical exertion goes up a notch, and the risk of injury to the joints increases as well.  You can expect one of the most common injuries in your group to be the ankle, wrist, knee, or finger sprain.

First, some anatomy: A ligament is a fibrous band of tissue that connects one bone to another, usually over a joint.  A “sprain” is caused when there is damage to a ligament because of hyper-extension beyond the normal range of motion.  This is different from a “strain”, which occurs when there is damage to a muscle or a tendon (its fibrous insertion into a bone).  A complete tear across a tendon or ligament is known as a “rupture”.

The most common signs and symptoms associated with sprains are bruising, swelling, and pain.  It’s a rare individual who has never experienced this injury over the course of their life.  Treatment for most sprains is relatively straightforward and follows the easy-to-remember R.I.C.E.S. protocol:

REST:  It is important to avoid further injury by not testing the injured joint.  Stop whatever actions led to the injury and you will have the best chance to recover fully.  Failure to rest is a common mistake for many athletes, who will continue to stress the joint by continuing strenuous activity.  As a result, the partially-healed ligament will re-injure itself and permanent damage may occur.  In a survival scenario, you may not have the luxury of rest; if not, expect chronic problems in the weakened joint.

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 useful to have in your backpack. Cold therapy should be performed several times a day for 30  minutes or so each time for the first 24-48 hours.   This is followed each time by applying…..

COMPRESSION:  A compression bandage 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.  Additionally,  an excessively tight wrap may affect the circulation, and you may notice the fingertips or toes becoming white or even blue.

ELEVATION:  Elevate the sprain above the level of the heart.  This will help prevent swelling at the site of the injury.  Swelling is caused by fluid that pools where the inflammation is (“edema”), and likes to accumulate where gravity will allow.  By elevating the leg, you allow the fluid to process itself back into your circulation and aid the healing process, or at least not impede it.  This also works for swollen ankles due to chronic medical problems, like high blood pressure; even pregnant women achieve relief from swollen ankles in this fashion.

STABILIZATION:  Immobilizing the injury will prevent further damage.  This may be accomplished by the compression bandage alone, or may best be supported with a splint or a cast if the patient is unable to place much weight on the joint.  Splints may be commercially produced, such as the very useful SAM splint, or may be improvised with sticks, cloth or pillows and duct tape.  Make sure the injured joint is immobile after placement of the splint.

I am often asked how to tell the difference between a sprain and a fracture.  Sometimes it’s quite easy, as when a straight bone is suddenly zig-zag in shape. Many times, it’s quite difficult and hard to determine without X-rays (which won’t be available in a long-term survival situation).

You can, however, look for one or more of these signs:

A fracture will generally have more pronounced swelling and bruising (but not always)

A fracture is generally so painful that no traction or pressure may be placed on the injury

A fracture may have a deep cut in the area of the injury (This is called an “open” fracture and is particularly dangerous due to the risk of infection)

A fracture may show motion in an area beyond the joint (if your finger suddenly has five knuckles, you probably broke it)

A fracture may present a grating sensation when pressing upon it

For sprains, Ibuprofen serves as an excellent anti-inflammatory and pain reliever.  Natural remedies also help, the underbark of willow, aspen and poplar trees have Salicin, a natural pain medicine.  Muscle relaxants, commercial or herbal, are more useful in strains than sprains.  Other natural alternatives include

certain essential oils to clear up bruising.  Apply 2-3 drops of oil of Helichrysum, cypress, clove, or geranium, mixed half and half with a carrier oil such as coconut or olive, 3-5 times a day on the area of bruising. To decrease swelling, apply Helichrysum oil, undiluted, to the affected area.  Ginger tea is thought to have anti-inflammatory properties; drink with warm raw honey, several times a day.

Common herbal pain relievers for orthopedic injuries include direct application of Oil of wintergreen, helichrysum, peppermint, clove, or diluted arnica to the affected area.  Blends of the above may also be used.  Herbal teas that may give relief are valerian root, willow under bark (as previously mentioned), passion flower, feverfew, and turmeric.  As always, drink warm with raw honey several times a day

Most sprains, (such as wrist and ankle sprains) commonly heal well over time using the R.I.C.E.S. protocol, natural or pharmaceutical pain relievers, 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.

It’s important to get joint issues dealt with while we still have modern medicine to help us.  If you need surgery to fix a bum knee, do it now.  In uncertain times, you (and your joints) want to be in the best shape possible to face the challenges ahead.

Dr. Bones