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 of icing.

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 therapy.

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.

Stretching:

1. 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 30 seconds.
2. 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 these stretches.

Range of Motion:

1. 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.
2. 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.

1. 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).
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.

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