Self Help

Treat your injury at home

 

Where to start

Advising people on how to manage their own injuries is not always a straight forward process. The key to successfully managing an injury is to ensure a definitive diagnosis. At Kingsley Physiotherapy, we understand that most people do not have their own physiotherapist or sports physician in their back pocket. That is why we offer our “Diagnostic consultations” . This is a fast and affordable way to have your injury formally diagnosed by a physiotherapist who can then guide you on how to best manage your injury at home. If you don’t live nearby, why not try our E-consult service or simply call us to get immediate advice over the phone.

 

Once an injury has been diagnosed and you are aware of the nature and severity of the problem (what tissues have been damaged and to what extent) applying the best treatment protocols is a much easier process and can make the world of difference in the recovery period. There are a few very good rules to abide by when managing an acute injury. If you are in doubt as to what to do, simply call our clinic and discuss your injury with one of our physiotherapists.

 

R. I. C. E. (Rest, Ice, Compression & Elevation)

This simple and familiar algorithm is a good set of rules to abide by for the first 24 to 48 hours after an injury. There are certainly exceptions to using this formula but unless you have had your injury formally diagnosed, you will be safe to apply these rules.

 

REST – Try to rest the injured body part. Reduce movement and function of the injured area. This may mean using crutches (in the case of a knee or ankle injury), or just sitting on the side-line for the remainder of the game. Immobilising an injury allows for faster clotting of damaged blood vessels (an essential first-stage in the tissue repair process) and reduces the risk of further traumatising the injured tissue.

 

ICE – The big claim-to-fame for ice is its ability to reduce pain. The effect of ice on reducing swelling is debatable and in most injuries, it’s unlikely to do very much. However, reducing the pain of an injury can substantially hasten the recovery process and hence ice is nearly always a good option irrespective of the injury that has been sustained. There are a few important exceptions to this rule (see below). Apply ice to an injury for 10 to 15 minutes every 1 to 2 hours for the first 24 to 36 hours. Do not interrupt your regular sleep habits to do this and ensure there are several layers of damp material (towelling) between the ice and the skin.

 

COMPRESSION – Applying pressure to an injury is perhaps the most beneficial of the four principals discussed here. Compression in the form of a bandage, taping or even the manual application of pressure with your hands can not only provide significant pain relief but can dramatically reduce swelling. Often injuries are simply too painful to compress in the initial few hours and hence ice or simple oral analgesia (such as paracetamol) may be a more practical option. Compression should be applied for the first 24 to 48 hours after an injury (at least). Your physiotherapist will be able to talk you through a “graduated decompression programme” as your injury heals – the variability of this programme makes it too lengthy to discuss on this website.

 

ELEVATION – Sustaining the injured body part above the level of your heart can be of benefit to reduce the amount of swelling that develops after an injury. Elevation can also help control pain though it is considerably less effective at this than the use of compression or ice. Elevation helps to reduce arterial blood flow (blood flowing toward the injury) and maximises venous return (blood flow away from the injury). Elevating an injury will also ensure that you are resting the injured limb.

 

Is ice all it’s cracked up to be?

The effect of ice on an injury is two-fold. Firstly, it causes the blood vessels to constrict (narrow). In so doing, this is thought to reduce bleeding into the injured tissues and hasten blood clot formation (an essential first-stage in the tissue repair process) and prevent secondary ischaemic tissue damage (injury to tissues that arises as a result of swelling impeding the blood supply to normal, healthy tissue). Secondly, applying ice also reduces pain. Reducing the pain of an injury enables more normal function and can help reduce secondary tissue responses such as muscle spasm or inflammation. Applying ice for longer than 10 to 15 minutes however may actually cause a reflex vasodilatory response –blood vessels respond to this local hypothermia by dilating (enlarging). Likewise, once ice is removed from an injury, the body compensates by dilating the blood vessels. This is the reason that ice applied to the skin will first result in a blanching (whitening) effect followed by a reddening of the skin as the blood vessels hyperdilate. So the jury is still out as to whether ice is really all it’s cracked up to be. However ice can be extremely helpful to reduce pain and that is never a bad thing.

 

When applying ice to an injury make sure there are several layers (3 or 4 at least) of damp material/towelling between the ice and the skin. Ice applied directly to the skin can result in quite substantial damage and scarring to the tissues. Alternatively, immerse the injury in a bucket of cold water and slowly add ice cubes (add 3 or 4 ice cubes every minute) until the water is sufficiently cold. Do not use ice over broken skin (where there is bleeding or exposed tissue/bone) and do not apply ice to ocular injuries (injuries to the eye-ball). If applying ice significantly worsens the pain of an injury, cease the application. Excessive pain can be an indication of neurological damage (damage to the underlying nerves) or bony fractures. Likewise, if you are unable to feel the initial coldness of the ice (lightly rub an ice cube over and around the injured area) do not continue with the ice application – numbness in the region of an injury may imply nerve damage and applying ice to a region with impaired sensation may unintentionally result in an ice ‘burn’.

 

When to apply heat to an injury

As a general rule, it is safest to apply ice to almost any injury during the first 1 to 2 days. In those situations where ice application is unlikely to have any positive effect (injuries to deep tissues) it is also very unlikely to do any harm. There are a few exceptions to this rule however. Some of those have been outlined above – ocular injuries, open fractures etc.

 

There are also situations in which applying heat will give significantly greater relief than ice applications. Most injuries to the spine fall into this category. Spinal injuries most commonly involve structures that are too deep below the skin surface for ice to have any practical benefit. Most spinal injuries, irrespective of the pathology, will result in some degree of muscle spasm – muscle tightness around the injured region. Applying heat to this area can provide a significant reduction in pain and will also have a loosening effect on these tight muscles.

 

Similarly, injuries that are more than a few days old may also benefit from heat applications in preference to ice. A good way to assess if heat can be applied to a non-spinal injury is to observe how the injury looks and feels. If pain is beginning to lessen (usually this is the case by day 2 or 3) and/or the swelling is starting to reduce, heat applications are preferred. Rest, compression and elevation (outlined above) are still encouraged during this period. It is advisable to return to ice applications at any time during the recovery period if the injury has been re-aggravated – i.e. if you observe an increase in pain or if you notice swelling is increasing. Often during the first 1 to 2 weeks, normal daily activities or returning to work are sufficient to trigger an increase in symptoms. During these times, return to at least 24 hours of regular ice applications.

 

There are several ways you can apply heat to an injury. Commercial gel-packs that can be boiled or wheat-packs that can be warmed in a microwave oven are ideal for heat applications. A folded damp towel can also be placed into a microwave oven to provide a make-shift heat pack. In some cases (particularly spinal or leg injuries), simply having a warm shower, bath or spa will serve the purpose nicely. Unlike ice, heat can be applied more consistently. Many people find great relief having warmth on their spinal injuries continuously. A heat pack tucked into the back of your pants is not a particularly attractive look but it serves the purpose well. Again be careful with heat applications if you are experiencing numbness in the area. Burns to the skin from heat packs are not uncommon and, like ice burns, can take a long time to recover and can scar the skin permanently.

 

Applying either heat or ice to a region should result in relief of your symptoms. If this is not the case, and certainly if your symptoms are worsened, cease the applications immediately and consult your physiotherapist or doctor.

 

Golden Rules for managing an injury at home

  1. IF IN DOUBT, USE ICE – Many people believe that ice is the best way to reduce the swelling of an injury. In reality, applying ice does very little to control swelling unless the injured tissue is superficial (close to the skin surface). Examples of superficial injuries where ice may be of benefit to reduce swelling include finger and toe injuries, ankle sprains, muscle tears and haematomas (corked muscles). Applying ice however, can greatly ease the pain of an injury and this alone can positively affect the healing process
  2. IF IT IS TENDER TO LIGHT TOUCH, USE ICE – this is one way of telling if the injury you have sustained is superficial. (Remember that you may well have sustained damage to deeper tissues as well). Conversely if your injury is only tender when you apply firm pressure, or if your pain feels ‘deep’ then ice is unlikely to do a lot to control the subsequent swelling. It still may be of benefit to help with the pain.
  3. USE HEAT ON SPINAL INJURIES – this is a good rule of thumb because nearly all spinal injuries (neck and back) involve deep tissues (tissues deeper than 10mm below the skin surface). Whereas applying ice to spinal injuries will do very little to control the pain and almost nothing to reducing inflammation, heat applications can substantially relieve pain and lessen muscle tightness in the area. Muscle spasm is a common occurrence in almost any spinal injury. In some cases the myofascial (muscle and connective tissue) response of a spinal injury can cause more pain than the initial pathology.
  4. AVOID MASSAGE, EXCESSIVE MOVEMENT AND DRINKING ALCOHOL DURING THE FIRST 24-48 HOURS AFTER AN INJURY – these can all contribute to excessive swelling and can substantially delay the healing process.
  5. SEEK PROFESSIONAL ADVICE FOR ALL HEAD AND NECK INJURIES OR WHEN THERE HAS BEEN A LOSS OF CONSCIOUSNESS.

 

If you have any further questions, or you would like to contact the physiotherapist best suited to managing your problem please call or email us. Alternatively, why not try our online e-Consult service? It’s free and can help you decide if physiotherapy is right for you.