COLD COMPRESSES FOR SPRAINS AND STRAINS

Sprains and strains are common injuries in many sports and part of the specialty treatment area of sports medicine. In addition to other care given for sprains and strains, cold compresses are often used as soon as any bleeding has been controlled.

How Cold Helps Initially

When a person twists an ankle or knee, the tissues underneath the skin are injured. Blood and fluids seep out from the torn blood vessels and cause swelling to occur at the site of the injury. Once bleeding has been controlled, cold can be applied to make the broken blood vessels constrict, thus limiting further blood and fluid loss.

Cold has been widely used as a first response to a sprain or strain, but recent research has shown that cold is best used only after any internal bleeding has been controlled, as cold inhibits clotting initially. For example, a likely ankle sprain requires initial first aid for the damage to internal blood vessels and muscle fibres, and cold can then be used in the second stage of treatment as an aid to recovery.

Injured tissue with bleeding and blood vessel damage.

Cold applied to injured tissue

Ice pack is applied to injured tissue, blood vessels contract and nerve endings are deadened, relieving pain.

Heat applied to injured tissue

Heat causes blood vessels to dilate with increased sensitivity to nerve endings.

Applying a Cold Compress

Soak a cloth or other suitable material in cold or iced water. Squeeze out any excess water so that the cloth is damp but not dripping and place it over the area of injury.
Replace the compress regularly or drip more cold water onto the old one to ensure that the cooling is maintained. Cool the injury for 10 minutes, then check the skin temperature and colour and remove the compress if reddening occurs.
If necessary, hold the compress in position with an open-weave bandage.

Applying an Ice Pack

Fill a plastic bag or ice bag half to two thirds full of crushed or cubed ice. Exclude all air, seal the bag and wrap it in a damp cloth. The ice pack should be large enough to cover the entire area of the injury.
Place the ice pack over the injury for a maximum of 10 minutes. Check the skin temperature and colour regularly and remove the ice pack if reddening occurs.

NOTES:
- Always wrap an ice pack in a damp cloth to avoid burning the skin.
- Elite athletes with larger muscle mass may need to have an ice pack applied for longer periods under medical supervision.

How Heat Helps Later On

A sports physician often advises applying ice to the injury after the initial first aid has been given. Ice packs may be applied for 10 minutes at a time and continued periodically for up to 72 hours or until the tissues are no longer hot to the touch. After that, heat applications may be prescribed. Heat speeds up the chemical reactions needed to repair tissue. White blood cells move in to rid the body of infections and other cells begin the repair process. Even though heat has a later role in treatment of an injury, always apply cold before heat and consult your doctor for clearance to start.

CARE FOR MUSCULOSKELETAL INJURIES

Some musculoskeletal injuries are obvious because they involve severe deformities such as protruding bones or bleeding. Also, the victim may be in much pain. Do not be distracted by pain as such injuries are rarely life-threatening. Complete the primary survey and care first for any life-threatening conditions. Then complete the secondary survey and care for any other injuries. Call for an ambulance, especially if:

The injury involves the head, neck or back.
The injury impairs walking or breathing.
You see or suspect multiple musculoskeletal injuries.

If an ambulance is on the way, do not move the victim unnecessarily. Control any bleeding and take steps to minimise shock. Monitor the ABC.

REMEMBER:

Sometimes it is difficult to tell whether an injury is a fracture, dislocation, sprain or strain. When in doubt, always treat such an injury as a fracture.

Soft Tissue Injuries

Injuries to muscles, ligaments and other soft tissues can occur with or without a fracture. If you do not suspect a fracture, control bleeding with rest, ice, compression and elevation. Apply ice after bleeding is controlled. A useful acronym to remember is RICE.

REST

Avoid any movements or activities which cause pain. Help the victim into the most comfortable position. If you suspect head, neck or back injuries, leave the victim lying flat.

ICE

Once any bleeding has been controlled, apply a wrapped ice pack or cold compress. Cold helps reduce swelling and eases pain and discomfort.

COMPRESSION

Apply a firm supporting bandage to give an even pressure over the injured area. Use light padding under the bandage if the pain is severe.

ELEVATION

Elevating the injured area helps slow down the flow of blood and reduces swelling. If possible, raise the injured area above the level of the heart. Remember, do not attempt to elevate a part you suspect is fractured until it has been splinted or fully immobilised.

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