Remote Primary Health Care Manuals

Sprains and strains

Swollen, painful joint caused by accident, injury, trauma

If no clear accident, injury, trauma — see Joint problems

  • Sprains involve ligament
  • Strains involve muscle or tendon
  • Soft tissue injury usually caused by strains or sprains — also consider dislocation, fracture, ligament/tendon rupture

Do not

Do not use or do these things (HARM) in first 2 days — makes soft tissue injuries worse

  • H eat
  • A lcohol (grog), aspirin, anti-inflammatory (eg NSAID)
  • R unning, strong exercise
  • M assage

Ask

  • What, how, when it happened
  • Location, type, amount of pain
  • Which way did it twist, was it hit, did they fall
  • Could they use limb straight afterwards, eg walk, hold things
  • What did they do for immediate management, eg did they ice it
  • Have they had a similar injury before

Check

Always compare sides

  • How person is holding or supporting joint
  • Joint assessment
    • Swelling, bruising, pain, redness, feels hot
    • Deformity (abnormal joint shape)
    • Open wound
    • Limited movement
  • If you suspect fracture — do fracture assessment

Do

Medical consult if

  • Pins and needles, numbness, loss of muscle strength
  • Severe pain on passive movement
  • Medium to large effusion (joint swelling)
  • You suspect dislocation, fracture, ligament/tendon rupture

Do — for sprains and strains

For first 2 days to let bleeding settle and lessen swelling — RICE

  • R est
    • If unable to bear weight — give crutches
    • Collar and cuff or simple sling to support arm
    • Splint or back slab if needed
    • Gentle movement within limits of pain
  • I ce
    • Do not put frozen material directly on skin — use wet towel between ice and skin
    • Put on for 15-20 minutes every 2 hours — reduce over second day
  • C ompression
    • Use tubigrip or bandage — firm but not tight enough to cause pain
    • Put on after ice
  • E levation
    • Ankle or knee — at least to hip level
    • Arm in sling or on pillows
  • Give pain relief
    • Use regular doses rather than waiting for pain to get bad
    • Back slab may help

Review after 2 days

  • If large amount of swelling and/or pain — recheck for instability (extra movement) of joint. Could be ligament or tendon rupture
  • Stop use of crutches or sling if pain allows
  • Encourage normal walking pattern
  • As swelling gets better — stop using tubigrip or bandage
  • Start active movement then strengthening exercises as soon as possible
  • Start using heat instead of ice
  • Encourage massage if tolerated

Medical consult if

  • Unable to walk or has severe pain with movement after 2 days
  • Moderate swelling remains after 5 days

Follow-up

  • Examine persons walking pattern and encourage them to walk as normally as possible — consider physio referral
  • Recovery times
    • Grade 1 sprain (ligament stretched but not torn) — return to normal activity after 1 week
    • Grade 2 sprain (ligament fibres torn) — return to sporting activities after 6 weeks
  • Do not return to sport until can
    • Move joint normally and without pain
    • Balance normally, if lower limb
    • Do full training session without pain or swelling