Sprains and strains are a description of what happens to the muscles, and other non-bony structures connected to our bones, when they are put under excessive pressure or strain. The result is swelling, pain, bruising and loss or impairment of function of the affected area.

• The first thing you notice is pain, often severe. This is usually at the time of injury, eg "going over on your ankle" or twisting your knee, but some times the damage is done by repetitive and less major strains and the pain becomes apparent later and possibly even the following day.
• Swelling is often obvious, and this is usually very tender
• The area affected may be reddened and rather warmer than usual.
• Bruising usually appears, often away from the area most affected, as blood which is released from the damaged soft tissues (muscles, ligaments, and tendons) seeps out along the muscles and other structures before coming near the skin.
• Pain and swelling causes the part affected to be difficult to use normally.

If in doubt you should seek advice from a nurse, physiotherapist or a doctor. This may be available nearby at some sports clubs etc., or may come from your own doctor's team, or possibly the accident and emergency department at the hospital.

Most sprains and strains, although painful, can be dealt with by someone who knows first aid, but sometimes there is more extensive damage, eg a broken bone (fracture) or a complete rupture of a muscle or tendon. Sometimes even a straightforward sprain can lead to complications. So if in doubt seek professional advice.

The cornerstones of treatment are said to be RICE:

• Rest of the part of the body which has been sprained.
• Ice packs to the affected part. To do this, put crushed ice in a plastic bag (or use a bag of frozen peas), and wrap it in a damp tea towel, to avoid ice burns, and apply that to the area for as long as you can. This helps reduce and minimize swelling, as well as helping with the pain.
• Compression, with a crepe bandage or a stockinette tubular bandage, can help reduce swelling and discomfort.
• Elevation. This means, for example, having a sprained ankle up on a stool, or a sprained wrist supported in a sling.

In addition to this, pain relief and some reduction in inflammation can be provided by taking a non-steroidal anti-inflammatory drug, such as ibuprofen, if you are not allergic to, or likely to be upset, by this. (If in doubt ask the pharmacist or your doctor.)

Straight pain relief (analgesia) can be provided by taking paracetamol.

Some people find an embrocation or liniment applied to the skin helps, but this should not be used on sensitive or broken skin.

Physiotherapy treatments can often help with recovery.

Occasionally, your doctor might suggest a steroid injection. This acts rather like an anti-inflammatory drug, and reduces swelling, pain and inflammation, but the body's natural healing mechanisms are still needed to mend the tissues, and this will usually take quite a few weeks.

Things to watch out for

• If there seems more than just swelling, and the area has an unusual shape, consider the possibility that a bone might be broken, and consult with a doctor.
• If there is numbness or change in colour beyond the sprain, consider that the pressure in the area may be too much for vital structures such as nerves and blood vessels, and consult with a doctor.
• In general, if in doubt ask a professional.

Outlook

Sprains and strains take a long time to get back to normal. This is often longer than it takes to get over a broken bone, and may be up to three months. It often seems to be "two step forwards and one step back", but you will eventually get back to normal in most cases. Often, however, you are left with a slight weakness in the part you have sprained.

In general, after the worst stage, at the outset, it is better to remain active and mobile, while not over straining your self.

These are very general notes to cover strains and sprains as a whole. There are, of course, exceptions and variations depending on the part you have sprained, and individual circumstances. Your doctor, nurse or physiotherapist will guide you.

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