Sprains and strains: Management
Managing muscular sprains and strains
Fortunately, sprains and strains typically respond well to treatment.
Most injuries of this type will feel better after 2 weeks, although severe injuries may take several months to return to normal.1
Here we review the different approaches that could help your patient get back to enjoying their life.
Guideline recommendations for treating sprains and strains
Sprains and strains can be managed simply in the first 72 hours following the injury
According to guidance from the National Institute for Health and Clinical Excellence (NICE), patients with sprains or strains should be advised to follow the PRICE and HARM protocols in the first few days after the injury.2
PRICE protocol for sprains and strains
PRICE stands for:2
- Protect from further injury (e.g. by using joint supports)2
- For the first 48–72 hours after injury2
- Apply ice wrapped in a damp towel for 15–20 minutes every 2–3 hours during the day for the first 48–72 hours after injury2
- With a snug (not tight) elastic or tubular bandage, whilst the patient is awake2
- Keep the injured area raised and supported on a pillow until swelling is controlled2
The PRICE protocol summarises how patients can take care of their sprain or strain in the first few days after the injury.
HARM protocol for sprains and strains
HARM describes some key factors to avoid in the first 72 hours after injury:2
- Avoid heat sources such as baths and heat packs2
- Avoid alcohol, which can increase bleeding and swelling and reduce healing2
- Avoid running or other forms of exercise that can cause further damage2
- Avoid massage, which can increase bleeding and swelling2
The HARM protocol summarises what patients should avoid in the first 72 hours after injury if they have a sprain or strain.2
Analgesics can be used to relieve pain from sprains and strains
Paracetamol or topical medications such as non-steroidal anti-inflammatory drug (NSAID) gels can be used for sprains and strains.2–4
Codeine can be added on, if prescribed.2
Oral NSAIDs can be considered 48 hours after the injury, if needed.2,4
Utilising physical therapy to improve outcomes
Physiotherapeutic interventions can be beneficial for soft-tissue injuries
Treatment and rehabilitation plans must be individually tailored to maintain and improve range of motion, reduce pain and inflammation, and improve functional activities.
For example, massage therapy can reduce stiffness and muscle soreness – although this should not be used in the first few days after the injury.
Appropriate strengthening programmes using tailored exercises are often required in the longer term to maximise recovery, and training regimens may need to be adjusted.5
Using multimodal approaches to relieve pain from sprains and strains
A multimodal strategy is helpful
Pharmacological and physiotherapeutic interventions can be combined into a multimodal approach for managing sprains and strains. Guidelines recommend a range of intervention types.2
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