The summer sports season (perhaps a little late), gardening and other outdoor chores will be starting soon. If they haven’t already, weekend warriors will soon be doing all sorts of things to keep doctors who treat musculoskeletal injuries busy. I want to give everyone some pointers in how to take care of the inevitable sprains and strains of spring and summer.
It’s interesting to me how many people come to my office after suffering an injury and don’t have any idea how to do some initial first aid. It’s extremely important to treat injuries immediately to prevent additional damage and disability.
When a musculoskeletal injury occurs, a biochemical chain reaction is triggered to begin the process of healing the injury. Injured cells release various messengers that start the process, but this also results in pain and swelling. The intent of this inflammation is to get the person to rest the injured area so it can heal. We naturally want to try and avoid pain and swelling.
The goal of orthopedic and sports medicine is to promote healing of an injury, but to also to try and speed up the recovery process. We used to think the best way to do achieve this was to prevent or slow the body’s normal inflammatory processes. However, our traditional treatment methodology may need to be tweaked.
You may recall the memory aid “RICE” that we have traditionally used to recall how to treat acute injuries. RICE stands for Rest, Ice, Compression and Elevation. This term was originally coined by Dr. Gabe Mirkin in his 1978 best-selling book, “The Sportsmedicine Book.”
The “R” in RICE stands for Rest. If you have a strain or sprain, you should not continue to try and use the injured body part. Many people get up and dust themselves off and continue their activity, only to suffer additional injury or more severe problems later that evening or the next day. Everyone knows how stiff and sore an injured body part can be the day after it occurs. I like to have people rest for a day or two following an injury and then try to get them up and moving a bit. Staying inactive for too long leads to stiffness, reduced motion and delayed recovery.
The “I” in RICE stands for Ice. We have traditionally recommended immediate icing after an injury. Recently, after a review of current medical literature, Dr. Mirkin has re-examined his stance on icing. He is also not alone in advising caution when trying to shut down inflammation with oral medications.
It appears applying ice does reduce inflammation, but after about five minutes it also causes constriction of blood vessels that reduces release of Insulin-like growth factor 1 (IGF-1). This hormone is important for tissue growth and repair. Dr. Mirkin is now recommending application of ice for no longer than five minutes, and only for the purpose of decreasing pain. It will likely take a few years for reduced icing to be accepted in the sports medicine community.
The “C” in RICE stands for Compression. You should apply something like an ACE bandage, neoprene sleeve or splint over the area to compress it and keep tissue fluid from accumulating. Swelling results in decreased blood flow to the area and delayed healing.
The “E” in RICE stands for Elevation. This goes along with compression. Elevating the injured area also helps prevent tissue fluid from accumulating. Typically, when we recommend elevation, we are talking about elevating the injured area a few inches above the level of the heart.
So, how long do you have to RCE an injury (note I left out the “I”)? I usually advise a minimum of 24-48 hours post-injury. At that point the body’s inflammatory reaction has started the repair process. After that initial rest period, you can slowly move the injured area to start to work on regaining normal motion. Depending on the injury, you may also need formal instruction in rehabilitation by a physical therapist or athletic trainer. Musculoskeletal injuries often result in weakened muscles that need to be strengthened and re-trained to return to proper function and protect the involved area from additional injury.
Taking NSAID medications like ibuprofen (Motrin, Advil) or naproxen (Aleve) is controversial in the treatment of musculoskeletal injuries. Like ice, these medications blunt the immune response and decrease the release of hormones like IGF-1 that may actually slow recovery. It’s best to stick with acetaminophen (Tylenol) initially and talk to your health care provider before using these anti-inflammatory medications.