A sprain is an injury to a ligament. 'RICE' (Rest, Ice, Compression, and Elevation) is commonly advised for the first two days after injury. Painkillers may be needed. Most sprains heal over a few weeks. Physiotherapy or surgery may be needed for severe sprains.
What is a sprain?
A sprain is an injury to a ligament. Ligaments are strong tissues around joints which attach bones together. They give support to joints. A ligament can be stretched during a sudden pull. This may partly tear some of the fibres in the ligament. Occasionally, a ligament may fully tear (rupture).
A damaged ligament causes inflammation, swelling, and bleeding (bruising) around the affected joint. Movement of the joint is painful. The aims of treatment are to keep inflammation, swelling, and pain to a minimum, and to be able to use the joint normally again as quickly as possible.
Treatment of a sprain for the first 48 hours
Think of RICE - Rest, Ice, Compression, Elevation.
- Rest the affected joint for 48 hours after injury.
- Ice should be applied as soon as possible after injury for 10-30 minutes. Less than 10 minutes has little effect. More than 30 minutes may damage the skin. Make an ice pack by wrapping ice cubes in a plastic bag or towel. (Do not put ice directly next to skin as it may 'ice-burn'.) A bag of frozen peas is an alternative. Gently press the ice pack onto the injured part. The cold from the ice is thought to reduce blood flow to the damaged ligament. This may limit pain and inflammation. After the first application, some doctors recommend re-applying for 10 minutes every two hours (during day time) for the first 48 hours.
- Compression with a bandage will limit swelling, and help to rest a joint. A tubular compression bandage is used for most joints. Mild pressure that is not uncomfortable, and does not stop blood flow, is ideal. A pharmacist will advise on the correct size.
- Elevation aims to limit and reduce any swelling. For ankle and knee sprains, keep the foot up on a chair to at least hip level when you are sitting. (It may be easier to lie on a sofa and to put your foot on some cushions.) When you are in bed, put your foot on a pillow. For hand or wrist sprains, use a sling with your hand and wrist higher than your elbow.
Treatment of a sprain 48 hours after injury and beyond
- Movement should replace rest. For most sprains this will simply mean starting to use the injured joint more freely. Don't do anything that causes much pain, but gently get the joint moving again. Sometimes it means doing gentle exercises several times a day. The aim is to get the joint moving in all normal directions, and to prevent it becoming stiff. Sometimes an exercise programme under the supervision of a physiotherapist or other health professional is helpful for sports people, or for severe sprains. However, you should not play sport or do vigorous exercise involving the sprained joint for 3-4 weeks after an injury.
- Compression bandages. You may be advised to remove the bandage after 48 hours. This is because the bandage may limit movement of the joint which should normally be moving more freely after this time. However, bandages of the leg, knee or ankle are sometimes kept on for longer to help keep swelling down and to keep the affected joint more comfortable.
- Heat and massage may be soothing. These have the opposite effect on the blood flow than ice. That is, they encourage blood flow. This may help the healing process. But, you should not use heat within the first 48 hours after injury when inflammation is developing. You can apply heat by using a hot water bottle, soaking in a warm bath, or using a hot cloth.
- Physiotherapy may help for more severe sprains, or if symptoms are not settling. A physiotherapist may advise on exercises and give heat, ultrasound, or other treatments.
Ruptured (torn) ligaments, and other severe sprains sometimes require surgery.
Medication for sprains
- No medication may be needed if the sprain is mild.
- Painkillers such as paracetamol are useful to ease pain. It is best to take paracetamol regularly, for a few days or so, rather than every now and then. An adult dose is two 500 mg tablets, four times a day. A doctor may prescribe additional painkillers such as codeine if the pain is more severe.
- Anti-inflammatory painkillers are an alternative. There are many types and brands. They relieve pain and may also limit inflammation and swelling. You can buy two types (aspirin and ibuprofen) at pharmacies without a prescription. You need a prescription for the others. Side-effects sometimes occur with anti-inflammatory painkillers. Stomach pain, and bleeding from the stomach, are the most serious. Some people with asthma, high blood pressure, kidney failure, and heart failure may not be able to take anti-inflammatory painkillers.
- Rub-on (topical) anti-inflammatory painkillers are another alternative. Again there are various types and brands. You can buy one comtaining ibuprofen at pharmacies without a prescription. You need a prescription for the others. There is debate as to how effective rub-on anti-inflammatory painkillers are compared to tablets. Some studies suggest that they may be as good as tablets for treating sprains. Some studies suggest they may not be as good. However, the amount of the drug that gets into the bloodstream is much less than with tablets, and there is less risk of side-effects.
See a doctor if:
You are concerned about the injury or the injury is severe. In particular, if:
- You suspect a bone may be broken or a ligament is ruptured.
- You have a lot of tenderness over a bone.
- The pain is severe, or if you cannot walk because of an injury.
- Bruising is severe.
- Symptoms and swelling do not gradually settle. Most sprains improve after a few days, and the pain eases. However, the pain may take several weeks to go completely, especially when you use the injured joint.
Preventing sprains
Always warm up before doing vigorous exercise. Ankle sprains are, by far, the most common sprain. Use good supporting footwear for sport. Do not do occasional bouts of vigorous exercise. Instead, aim for a general and steady build-up to fitness.
©EMIS and PIP 2005
