Recently I have been treating a lot of sprained ankles because one role a physiotherapist has is the treatment of soft tissue injuries. This will vary depending on the nature and severity of the injury. It is advised to always seek prompt medical attention following an injury as this will ensure an accurate diagnosis and the correct specific care. However there is some generic research based advice that can be followed immediately after an acute soft tissue injury.
The acronym PRICE Protection, Rest, Ice, Compression and Elevation remains one of the most popular approaches to management for the first 24-72 hours following injury.
Protection: a short period of protecting the injured area through unloading/not using the injured area is required after the majority of soft tissue injuries. However excessive protection (and rest) and unloading of the joint can do harm. This is one reason why it is important to seek advice about how to progress the loading of the joint during the first few days post injury.
For example an ankle sprain: using elbow crutches to walk with for the first 24-72 hours will help unload the ankle joint and so protect it but it is important to wean off the crutches and start loading the joint at the correct time.
Rest: if the injury has occurred during an activity then cease the activity immediately. Resting the injured area helps prevent further damage and avoids further pain. However, as discussed previously excessive rest for excess of 72 hours can do harm.
Ice: standard application of ice is for 20 minutes over the injured site every 2 hours for at least the first 6 hours following the injury (the skin must be intact). The ice can help with reducing the pain and there is some evidence that ice can help with inflammation.
Compression: applying a firm (but not so tight it causes discomfort) bandage to the injured area can provide support (which can help with confidence as the injured area can feel more supported). It can also help reduce local bleeding and swelling.
Elevation: placing the body part higher than the heart (if possible) can help reduce the accumulation of excess fluid (swelling) in the area. Elevation can be achieved by wearing a sling for the arm or placing the leg on a stool or in lying with it rested on pillows.
In addition to the above advice, it is important to avoid the following HARMful activities for the first 72 hours following the soft tissue injury:
Heat: avoid hot baths, heat packs, saunas and heat rubs because heat can increase bleeding and swelling at the injured area.
Alcohol: it may mask pain and the severity of the injury increasing the risk of re injury. It can increase swelling, bleeding and delay healing.
Running/moderate activity: it can cause further damage to the injured area.
Massage: Vigorous massage to the actual injured area for the first 24-72 hours post injury could cause further bleeding, swelling and pain. Massage in areas away from the injury maybe beneficial but that should be determined by a qualified professional.
The advice given above is for the first 24-72 hours following an acute soft tissue injury. Post 72 hours, rehabilitation to reduce pain, increase movement and strength of the area and increase balance (for a leg injury) is required. The treatment plan will depend on the location, severity and nature of the injury. If you ever have any questions or are unsure how to proceed following the injury, always seek medical advice.