Simple though they may sound, sprains and strains can make you
miserable from days to months, if not treated properly. A sprain
is an injury to a joint as a result of twisting or wrenching without
complete dislocation, and it results in pain and swelling. Sprains
involve ligaments: bands or cords of dense connective tissue that
run from one bone to another, providing the joint with stability.
While sprains can involve most any joint, the most common injury
in non-athletes is a sprained ankle. Sprains are classified into
three levels, from moderate to severe, depending upon whether
the ligaments are stretched, partially or completely torn. A strain
is a stretch, tear or rip in a muscle or its tendon (the structure
which connects the muscle to the bone). Both need attention to
speed recovery and prevent long-term dysfunction.
First, RICE . . .
Your first-aid, immediate treatment for sprains and strains
is RICE, an acronym for Rest, Ice, Compression and Elevation.
Rest the joint or affected area by not using it and keeping your
weight off of it. Put ice on the injury to help control swelling.
This should be done four times per day for 20 minutes during the
first 48 hours following the injury. Apply compression with an
Ace-type bandage, but be careful not to wrap it too tightly and
cut off circulation. Finally, elevate the area above your heart
(if applicable) to avoid blood pooling and increased swelling.
Once swelling has subsided (after the first 48 hours, or so) heat
should be applied to the area on the same schedule as you that
If you still have significant pain, swelling or substantial limitations
in the joint's range of motion or ability to bear weight on the
third morning following your injury, you should consult a professional.
Your Physician or Nurse Practitioner
Your physician or nurse practitioner will begin your injury
evaluation by taking a history of the event and symptoms (onset,
location, duration of the problem, any prior injury history, aggravating
factors, relieving factors). She will then examine the area to
determine the extent and severity of the problem. She may recommend
that you have an x-ray if indicated. If you have severe pain,
swelling or muscle spasms, you may require prescription medication.
Over-the-counter medications such as Advil or Tylenol will help
with mild to moderate discomfort. Topical analgesic rubs can also
provide relief for muscle strains. Your physician or nurse practitioner
can also recommend crutches, slings or splints, if needed for
more serious injuries.
Follow your practitioner's instructions for icing more serious
injuries, since they may require additional icing (up to 72 hours)
before the heat phase can begin. For severe injuries, you may
be referred to an orthopedist, and/or chiropractic care or physical
Chiropractic Care and Acupuncture
Your chiropractor takes a "hands-on" approach to treating
sprains and strains. Your physical evaluation will include palpation
(feeling the area) and examination. You may also receive special
tests, such as orthopedic, muscle strength, muscle length and
joint range of motion.
Chiropractic care may involve appropriate physical therapy modalities
to reduce pain and speed healing. You may first receive deep tissue
massage, electrical muscle stimulation or heat therapy. Chiropractic
spinal adjustments may be indicated as well as passive and active
stretching. You may also require arm or leg joint mobilization
and/or manipulation followed by instructions for special exercises
you can do on your own. Chiropractic care will help restore normal
joint motion, nerve transmission and blood flow, reduce pain and
swelling, and speed healing.
Acupuncture stimulates the body to create its own natural pain-killing
chemicals, which often mean immediate pain relief with treatment.
Acupuncture also increases local circulation, reduces swelling
and speeds healing. In the acute injury phase, acupuncture treatments
would be given every other day for two weeks. Your acupuncturist
may also apply herbal creams or external plaster mixtures.
Rehabilitation from Your Injury
A balanced approach to recovering from your injury is best.
The longer you remain inactive, the longer your recovery time
will be. On the other hand, if you do too much too soon, you can
set yourself back. Ligaments and tendons take about six weeks
to heal, but muscle tissue heals more quickly. It also helps during
the initial stages of recovery to use a brace, especially to support
ankles and knees. Turn the page for some general guidelines along
with some specific exercises for ankle sprains, a common injury.
Step One - Stretching it Out
Once your pain and swelling has subsided and you are able to
move on from the rest stage of the injury, the first step is to
improve range of motion. This means beginning to restore the level
of movement to the joint or muscle that you had before the injury.
If you are working with a professional, follow their instructions
and use the specific exercises you are given. Following are some
examples for rehabilitating the ankle.
- Stand about 18 inches from a wall with your feet turned in
slightly (pigeon-toed), heels on the floor. Now place your palms
against the wall at head level, slowly bend your elbows and
gradually bring your chest closer to the wall. While you're
leaning, keep your body straight. Hold the stretch for 10 to
- Stand with your feet about six inches apart, feet flat on
the floor. Keep your back straight and bend at the knees until
you feel tightness in your calf muscles. Hold for 10 to 30 seconds.
Note: Repeat both stretches five to ten times each session and
repeat your sessions two or three times each day. You may also
need to bear a little extra weight on your good leg as you do
Range of Motion:
- Sit on a sturdy surface or drape your leg over the arm of
a chair or sofa so that it can hang freely. Now slowly flex
the foot (bring the top of the foot closer to your shin) followed
by slowly pointing your toes toward the floor. Hold each position
for a count of three. Do three sets of ten repetitions each.
- When you can comfortably move your ankle up and down, try
tracing the alphabet in the air with your big toe. Work from
A to Z, and keep your movements slow and deliberate.
While progressing through your exercises, let pain be your guide.
If it hurts, back off until you feel more comfortable. To prevent
any swelling after your session, apply ice to your ankle for 15
to 20 minutes.
Step Two - Muscle Strengthening
You cannot strengthen damaged ligaments, but you can strengthen
injured muscles or the muscles around an injured joint to strengthen
its muscular support and help prevent future sprains. This is
a vital part of rehabilitation. It may seem like a lot of work,
but it is worth it now to prevent weakness, pain or further injury
in the future. Following are examples of a few ankle strengthening
exercises. Do these four to six times per day and finish with
15 to 20 minutes of icing in the early stages. You are ready to
begin your strengthening exercises after you have worked on stretches
and range of motion for two or three days. Again, follow professional
instructions, if applicable.
- Stand with the balls of your feet, toes pointing straight
ahead, on the edge of a step and hold onto the handrail to balance
yourself. Slowly lower your heels below the level of the step,
then rise up on the balls of your feet. Repeat ten times. Follow
with ten repetitions each with toes pointed out (duck-footed)
and toes pointed in (pigeon-toed).
- Sitting on the floor with your legs extended, hold the ends
of a stretchy exercise band (Dynaband or similar) and loop the
end around the ball of your foot, keeping the band snug. Now
point your toes as far forward as possible, hold and release.
- Make a loop with your band, secure one end and wrap the other
end around the top of your foot, sitting on the floor with your
legs extended and the band pulled snugly. Now flex your foot,
pulling the top of it toward your shin, hold and release.
- Place a sturdy chair near your band so that you can sit in
the chair and loop the band around the outside of your foot,
again with band snug. With your heel on the floor, slowly pivot
your foot out to the side, hold and release.
- Loop the band around the inside of your foot, and with heel
on the floor, slowing pivot your foot inward, hold and repeat.
Note: Do ten repetitions of each band exercise.
- Once you have been doing your strengthening exercises for
a few days, try a balancing exercise to restore the ankle's
coordination. Without holding onto anything, stand on the injured
leg for 10 to 20 seconds. Try first with eyes open, then with
eyes closed. Practice until you can balance for two minutes.
For safety, stand near a sturdy object so that you can steady
yourself if you lose balance.
Step Three - Getting Back to Normal
Once you can walk without a limp and feel no pain (or use the
joint or muscle and feel no pain), you can begin to get yourself
moving again. If you are working with a professional, be sure
to get their approval to resume normal activity. Once you have
approval, you'll need to begin gradually. Start with low-impact
activities (water exercise, walking, cycling) for shorter durations.
Work up gradually if you feel no pain, hold up if pain recurs.
Find a licensed acupuncturist here: "Resources
for Finding Acupuncturists and Herbalists"
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