I have seen thousands of patients over the years, but as I walk into clinic
each Monday morning and peruse my patient list, I know somewhere on that
list is a patient with a story I have never heard before. I have heard
some doozies that would make your ears burn or your belly ache with laughter.
They usually start with, “Hey doc, you’re not gonna believe
this but . . .” and the tale unfolds.
Let’s say, just for a moment, that one of these unfortunate events
happens to you. You’ve fallen, and you can’t get up. Now what?
You’re sitting there, having just fallen off a ladder, thrown 1,000
pitches to your eight year old or completed eighty bazillion burpees at
CrossFit, and now you are rubbing whatever hurts and wondering what you’ve
done to yourself. First, rule out the red flags. Is there any deformity
or blood that may portend something more serious, like a fracture or dislocation?
Is the area uncharacteristically swollen? Immediate swelling can be secondary
to a fracture or a ligamentous injury. On the Monopoly board of injuries,
these signs are analogous to, “Do Not Pass Go! Do not collect 200
dollars,” and go straight to an ER or Immediate Care Center.
No red flags? Move on.
If you’re lying down while making your assessment, then sit up and
let your blood pressure equilibrate. Pain can cause a vagal response and
drop your blood pressure. If you’ve ever seen me on a football field
with one of those 300-pound linemen, then you know the first thing the
trainer and I always do is sit him up for a minute before he tries to
walk off the field. This is because I don’t want a walking refrigerator
to fall on me. Next, try to put a little weight on the joint and try moving
it to test your range of motion. Though it might be painful, if you can
place weight through the extremity, it’s probably not a fracture
or tendon/ligament tear but more of a strain or sprain.
Treatment: RICE? RECI? CIER? ICER?
RICE is a well-known acronym for Rest, Ice, Compression and Elevation that
is used to treat soft tissue injuries and should be the first course of
action before making an appointment with your doctor. In the acute phase
of an injury, it is best to ice the extremity at least two to three times
per day for 15 to 20 minutes for two to three days. People ask me what
type of ice pack I recommend, and my answer is a bag of frozen corn or
peas. These stay very cold for twenty minutes and conform to the shape
of all joints and extremities. They can be used in tandem with a four
inch ACE bandage for a compressive effect. During the placement of ice
and throughout the day, elevation above the level of the heart should
be used to decrease any swelling.
Ice, compression, and elevation are usually easy treatment parameters;
it’s the rest component that most people have a problem following.
For most of my running patients, rest means taking three days off and
then pounding the pavement again. It’s amazing how many wide-eyed,
open-mouthed, aghast looks I receive when I tell them that three days
is probably not long enough. For most sprains and strains, complete recovery
takes four to six weeks. I refer to this as one orthopaedic unit. Rest
should be a graduated increase in activity beginning with limited weight
bearing/lifting on the injured extremity for 48 to 72 hours, followed
by gentle range of motion exercises. During this time, lower impact exercises
can be initiated with the goal to increase to full activity at the end
of the four to six week period.
Still hurting after all of this?
It’s time to see a doctor. When you have exhausted all of the treatment
options you can accomplish on your own but you still have pain, you should
make an appointment with your physician to rule out any more serious injuries.
At this point, you are probably frustrated and just want to get back to
your normal self. If you follow the steps listed above, it will help your
physician identify your issue faster and more efficiently. More proactive
self-treatment equals less time in waiting rooms reading Highlights magazine.
That’s a win for everyone.