Here we introduce how to deal with sprains and strains. We show how to deal with minor sports injuries.
We are very lucky to have doctor John Heaton at the surgery who specialises in orthopaedic and sports medicine, who can also provide acupuncture treatment where needed.
The immediate care of common sports injuries (sprains, strains, bruises, etc.) consists of a four step programme that should be followed as soon as an injury occurs. The four part programme is called RICE, and stands for Rest, Ice, Compression, and Elevation.
As soon as an injury occurs, it is important to stop the activity immediately, otherwise you risk further damage to the injured part. When a body part has become injured, the body reacts with an inflammatory process which causes swelling, redness, local increase of heat in the area and pain. The degree of each of these dependant on the severity of the injury.
Put ice on the injured part as soon as possible after the injury. Ice or cold, specifically, controls swelling by constricting the blood and lymph vessels, decreases muscle spasms (which often accompanies injury), and decreases some of the discomfort and pain caused by the inflammation. By reducing llic swelling that collects around the injured area, the rehabilitation time will be lessened and you will be able to return to your sport more quickly. The ice should be applied for 15-20 minutes. To obtain maximum benefit, apply ice every 3 hours As the pain and swelling decreases reduce the application of ice to twice daily. The ideal time to apply the ice is after performing any exercises given to you by your doctor or Physiotherapist. Under no circumstances should any form of heat be applied e.g. hot bath which would increase swelling and inflammation.
Applying an ice pack:
1. Make an ice pack by filling a cold damp towel with ice cubes or frozen peas
2. Get comfortable with the injured part well supported in elevation
3. Rub a small amount of oil (e.g. baby oil) on the injured area to prevent an ice burn
4. Put the ice pack over the injured area for 15-20 minutes (you will notice the skin turning pink)
Compression also helps to limit swelling in the injured area. After the ice treatment apply the tubi-grip bandage you may be prescribed or advised to purchase by your doctor. The tubi-grip should be worn continuously until the swelling has subsided (about 48-72 hours).
Immediately following your injury, elevate the injured limb above the level of your heart to limit the development of swelling. This can be done by raising the affected part on a stool or similar with the limb well supported with pillows or cushions. Raising the injured limb above the level of the heart may be impractical at work or other situations. Some elevation, however, is better than none at all. For example, resting the affected leg on a stool or chair whilst sitting for knee or ankle injuries. Continue with compression and regular elevation until the swelling has disappeared. Compare your injured side with the other side to determine whether swelling is present or not.
We are also very lucky to have a physiotherapist that visits the surgery from the Leicester Royal Infirmary on 3 days a week.
We are also very lucky to have a fully trained chiropractor who comes to the surgery twice a week.
Referral to both of these in house services is by appointment from a Dr only. They can decide which service is the best for your orthopaedic/back problem.
Waiting lists at these in house services are usually a couple of weeks and are on average shorter waiting lists than the local hospitals.
Strains and Sprains
If you can get to us we have a specialist "cryo-bandage" which we use to treat ankle, knee, wrist and elbow sprains. Ensure you tell the receptionist when you arrive that you have strained/sprained a joint, so we can use the equipment as soon as possible.
If you cannot get to us you need to apply a cold compress yourself, e.g. a pack of frozen peas or crushed ice wrapped in a towel. Repeatedly apply for ten minutes then take away for ten minutes.
Caution: It is dangerous to leave a cold compress against the skin for longer than ten minutes, as frostbite can occur, and it must always be wrapped in a towel or cloth, never placed directly onto the skin.
After ice treatment, a firm bandage may give support. Rest the affected area and if your ankle or knee is affected, raise it above the hip level to reduce swelling.
· Source: LSMP
Back pain - modern management
Back pain is very common. Most people will have one or more bouts of back pain at some point in their life. Most bouts resolve within a few weeks, and serious or permanent damage is rare.
UNDERSTANDING THE BACK
Your spine is one of the strongest parts of your body. It is made up of solid bony blocks (called vertebrae) joined by discs of strong rubber-like tissue which allows the spine to be flexible .It is reinforced by strong ligaments, and surrounded by large and powerful muscles that protect it.
Most cases of back pain that develop suddenly are due to ‘simple back pain’ rather than any serious disease. Most back pain comes from the working parts of your back - the muscles, ligaments and small joints. Your back is simply not moving and working as it should. You can think of it ‘being out of condition’. What you do about back pain yourself is usually more important than the exact diagnosis or treatment.
WHAT ARE THE TREATMENTS FOR SIMPLE BACK PAIN?
What you do in the early stages is very important. Rest for more than a day or two usually does NOT help and may actually prolong pain and disability. Your back is designed for movement: it needs movement - a lot of movement. The sooner you get moving and doing your ordinary activities as normally as possible, the sooner you will feel better. The people who cope best with back pain are those who stay active and get on with life despite the pain.
Even when your back is painful, you can make a start without putting too much stress on it:
In fact most everyday activities and hobbies - don't stop doing things, just change the way you do them
Either stay at work or return to work as soon as possible
Try to avoid staying in one position for too long – particularly sitting and standing. You may need to adjust your chair/desk and computer, and take regular breaks. You should also look at our advice on Computer Ergonomics, as poor posture when using computers is a common source of back and neck pain.
Anxiety and stress can increase the amount of pain we feel. Tension can cause muscle spasm and the muscles themselves can become painful. Many people feel anxious about back pain – but remember that serious damage is rare and that the long-term outlook is good .Do not let fear and worry hold back your recovery.
Regular pain killers may be needed initially to help control the pain and let you get started:
Paracetamol is often effective if taken regularly – for an adult this is usually 1000mg ( two 500mg tablets) taken four times a day
Ibuprofen ( anti-inflammatory painkillers) can be taken in addition to Paracetamol if necessary, usually in a dose of 400mg taken three times a day. Some people with asthma, stomach ulcers, high blood pressure, kidney failure or heart failure may not be able to take anti-inflammatory painkillers
Stronger painkillers such as Codeine are an option if anti-inflammatories do not suit you. Codeine can be taken in addition to Paracetamol. Codeine may cause constipation which can aggravate back pain if you need to strain to go to the toilet – have plenty of water & fruit in your diet to prevent this
All these pain killers are available from a pharmacy without a prescription.
WHEN DO I NEED TO SEE A DOCTOR?
Most people manage to deal with simple back pain themselves by following the advice in this leaflet. However if you have severe pain that gets worse over several weeks instead of better, or if you are unwell with back pain you should see your doctor.
Your doctor will normally be able to diagnose simple back pain from the description of the pain, and by examining you. In most cases no tests are needed. X-rays or scans of the back are not usually helpful in simple back pain.
Here are a few symptoms, which are all very rare, but if you do have back pain and suddenly develop any of these you should see a doctor straight away:
Difficulty passing or controlling urine
Numbness around your back passage or genitals
Numbness, pins and needles, or weakness in both legs
Unsteadiness on your feet
GETTING ON WITH YOUR LIFE
People who cope with the pain by being positive, staying active and getting on with life tend to get better faster and have fewer problems in the long run. Regular exercise and staying fit helps your general health and your back.
Source: Adapted from The Back Book - A reliable source of information for people suffering from low back pain [Roland et al, 2002]. It is written by a team consisting of a GP, orthopaedic surgeon, physiotherapist, osteopath, and psychologist and provides comprehensive advice.
The following information is to give guidance on basic ergonomics related to the use of computer equipment, which will reduce problems related to poor working postures. The way you sit when using a computer influences your entire body and adjusting your posture can help reduce aches and pains, and long-term musculo-skeletal problems.
Ensure the chair back is adjusted so that your upper body is relaxed and supported.
Your lower back needs to be supported by the chair, alter the angle so that your lower back is supported. You may still need extra support and can add a cushion in the small of your back. You should change the angle during the day to vary your sitting posture and avoid being in one static posture all day.
Adjust your seat height. Sit in front of your computer and adjust your seat height so that your forearms are horizontal and wrists are straight when your hands are placed on the keyboard. With your shoulders relaxed the underside of the elbow should be at desk height.
If there is pressure on the back of your thighs find something to rest your feet on.
If your feet are not comfortable on the floor find something to rest your feet on. Shorter people often lower the seat so their feet are on the floor, but this can mean that your arms are not at the correct height for the keyboard.
The space under your desk should allow you to place your legs underneath without twisting or leaning, or being squashed under a low desk.
Double-check that your forearms are horizontal and wrists are straight when your hands are placed on the keyboard. With your shoulders relaxed the bottom of your elbow should be at desk height.
Ensure your wrists are not bent, use a wrist-rest (sometimes supplied as part of a keyboard, or can be purchased for £6 from stationers, computer shops, Argos).
- Adjust your screen position - the top of the screen should be level with your eyes and you will then naturally look at the centre of the screen. If using a CRT monitor it may be necessary to move your desk away from the wall, so that you can push the monitor further away from your head to create a comfortable viewing distance. Ensure that tired eyes/headaches may result in problems relating to reading your screen. Ensure you do not have reflections or glare and if necessary try moving your screen to a different angle. Avoid sitting with windows or lights directly in front or behind your screen. If possible, sit with the screen at right angles to light coming through windows, if not use window blinds or curtains to cut out the light. Adjust the brightness and contrast controls on the screen to suit lighting conditions. Remember to keep your screen clean, and have your eyes tested regularly.
Organise your work area, ensure the keyboard and mouse are close when in use, that the desk is not cluttered. Use a document holder to raise documents to a comfortable height and viewing distance.
Laptop users should purchase a laptop stand (can be purchased for £15 from stationers, computer shops, Argos), so that the keyboard and screen are elevated to a more suitable height and position. If possible attach a separate keyboard and mouse (can be purchased for £10 from computer shops, Argos), so that you are best able to position the keyboard, mouse and screen. Laptop use is a major source of musculo-skeletal problems, and using a laptop for any length of time without a laptop stand, and separate keyboard and mouse, will cause poor posture which is likely to cause neck, back, and arm pain.
ORGANISE YOUR WORKING DAY
Try and ensure your computer work is interspersed with other jobs. Rotate activity to avoid long periods of time in front of the screen. Short frequent breaks are much more effective in reducing muscle fatigue than taking longer breaks less often. During your breaks: DO - Get out of your seat, stretch your legs, arch your back, walk around for a couple of minutes, try Pause Gymnastics (see below). DON'T - remain seated at your desk.
These are simple movements designed to move joints and stretch the muscles and nerves, will stimulate the circulation, lubricate the joints and relieve muscle and nerve tightness. They can be done sat at your desk, and take only a few minutes to do:
Stretch your head from side to side (i.e. ear to shoulder)
Breathe in, pull the chin in to make a double chin, hold for 5 seconds then relax
Stand up, put the palms in the small of the back, and gently bend backwards
Interlock the fingers; turn the palms to face away from you and lift the arms up so the palms face the ceiling Now stretch the arms back behind the head
Stretch the arms back to each side at about hip height Keep the elbows straight and then bend the wrists back (palms facing out). Try to get the arms as far back behind the body as possible You may feel some pulling in the arms and hands
Gently curl the fingertips of the right hand into the palm. Keep the right elbow straight and with the left hand passively bend the right wrist so that the palm side of that hand moves towards the inside of the forearm. Repeat on other side
You need to do these movements regularly, one or two stretches every 20 minutes are better at relieving fatigue than longer exercise breaks taken less frequently. Make the exercises automatic so you do not have to think about doing them.