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Release Date: 8/27/2012

Treat painful strains, sprains with RICE

Julie Busch, M.D.

Julie Busch, M.D., Family Medicine Specialist

It’s your daughter’s first soccer game of the season, and the clock is winding down, with the score tied at 2-2. She takes the pass, deftly side-steps a steal attempt and promptly crashes into another player. Her body twists to the right; her ankle, unfortunately, twists left.

Now you’re not sure if her tears are due to the pain in her rapidly swelling ankle or to the disappointment of knowing she could be sidelined for the season. “It’s probably a sprain,” says the coach. “It might be a strain,” the referee puts in. And you, the parent, are wondering, “What the heck is the difference?”

A sprain is an injury to a ligament, the tissue that connects your bones to each other. A strain is an injury to either a muscle or a tendon, the tissue that connects muscle to bone. Injuries in both cases generally involve abnormal stretching or tearing. Both cause pain, swelling and restricted mobility. Additionally, sprains may be accompanied by bruising; strains, by spasms.

Sprains are caused when a joint is forced to move into an unnatural position, as a “twisted” ankle. The ligament is stretched too far or actually tears. Strains are cause by excessive physical activity or effort, lack of warm-up and poor flexibility. Both sprains and strains occur when the muscles, tendons and ligaments are put under stress to perform movements for which they are not designed. Both may be caused by one single event or by repetitive activities.

In either case, the treatment is simple: RICE – rest, ice, compression and elevation for the first 24 hours after the injury. Reduce physical activity – rest the affected muscle for at least a day, then begin resuming normal activity in moderation. To reduce swelling, apply an ice pack to the injured area for 20 minutes at a time, four to eight times a day. Placing a compression bandage around the injured limb and keeping it elevated above the heart also will help decrease swelling. An anti-inflammatory medication may decrease pain and inflammation.

In most cases, strains and sprains resolve themselves in time. If the swelling doesn’t go down after two days or if signs of infection appear – redness and warmth at the injury site and/or fever, see your doctor. A severe injury may require physical therapy and/or surgery.

To make a diagnosis, your doctor will ask how the injury was sustained and will perform a physical examination. Occasionally, X-rays, CT scans or MRI scans may be needed to confirm a diagnosis or to further identify the injury.

Sprains and strains can’t always be prevented; but a few simple precautions can lessen your odds of sustaining one. Always wear properly-fitting shoes and replace athletic shoes that are worn down on one side or if the tread is worn out. Athletes should always wear appropriate protective equipment for their sport.

Warm up before participating in any sport or exercise and be sure you are in good physical condition before the season/tournament/event starts. Avoid any strenuous physical activity when you are tired or in pain.

Unfortunately, despite the best precautions, some injuries can’t be prevented. While most sprain/strain do not pose serious injuries, some require immediate medical attention. If there is bleeding at the injured site, if you suspect the bone is broken, if the joint appears to be deformed or if you hear a popping sound and have difficulty moving the joint, head to the nearest urgent care or emergency department.

Dr. Busch, a family practitioner, is a member of St. Anthony’s Physician Organization. She practices at Kirkwood Family Medicine, 10296 Big Bend Blvd., 314-543-5943. For a referral to any St. Anthony’s physician, call 314-ANTHONY (268-4669) or 1-800-554-9550.

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