FEATURE


as blood seeps across the joint and along muscle fi bres before surfacing into sight just below the skin. The severity of the symptoms involved usually refl ect the severity of ligament damage; a partial tear is less severe than a complete tear5


. STRAINS


A muscle strain is a stretching or tearing of muscle fi bres5


. This usually


occurs when muscle fi bres have been stretched beyond their capacity or if they have been forced to contract too strongly5.


Muscle strains are often graded on their severity. A fi rst degree strain is mild, involving just a few muscle fi bres. The muscle is painful and tender but has full strength. A second degree strain is moderate, involving a noticeable amount of swelling around the affected muscle, possible bruising and a considerable reduction in muscle strength. A third degree muscle strain occurs when a muscle tears completely into two pieces, leading to complete loss of muscle function5


. Symptoms of a muscle strain include:


• A history of pulling a muscle • Pain in the muscle


• Large Haematomas (as a result of tearing the intramuscular blood vessels)


• Obvious swelling • Muscle function can be affected,


Follow PRICE Protection


Protect from further injury, for example by using lace-up shoes to protect an ankle


Rest


Avoid activity for the fi rst 48-72 hours following injury


Ice


Apply ice wrapped in a damp towel for approximately fi fteen minutes every two to three hours during the day for the fi rst three days. Ice must not be left on whilst sleeping.


Compression


Tubular elasticated bandages should be supportive but not tight


depending on the degree of the strain


There are a number of factors which increase the risk of a patient developing a sprain or strain. These include:


• Poor conditioning – A lack of regular exercise makes joints weak and less fl exible, making injury more likely


• Poor technique – Weight distribution during exercise is important. Landing after jumping, walking and running can out someone at risk of an injury if executed incorrectly.


• Inadequate warm up – Prior to exercise, warming up helps to loosen muscles and increase joint motility, preparing the ligaments and muscles for intense exercise.


• Fatigue – Tiredness can inhibit the body from performing accurately. When muscles are tired, they are less able to support joints.


TREATMENT Table 1 outlines the PRICE and HARM acronyms which detail the advice pharmacists can provide in the management of both sprains and strains.


Table 1 outlines the management of sprains and strains through PRICE and avoiding HARM5


Sprains and strains should be referred to an emergency department if any


of the following criteria are met or suspected:


• Fracture


• Inability to bear weight (walk four steps)5


• Dislocation • Damage to nerves or circulation • Tendon rupture • Bleeding disorder


• Septic arthritis (fever, swollen joint warm to the touch)


• Haemarthrosis (very painful, tender and swollen joint immediately after the injury)5


• Numbness, coldness or discoloration of the injured area


In terms of analgesia, paracetamol is the mainstay of treatment. Topical NSAIDs are an option, however oral NSAIDs should be avoided for at least 48 hours after the injury has occurred as it is thought that they may delay healing. It is worth noting that ketoprofen is associated with photosensitivity reactions and piroxicam has had reports of interstitial nephritis, nephrotic syndrome and renal failure5


.


There is a vast array of compression bandages and supports available to customers over the counter. Crepe bandages, cotton crepe, polyamine and elastane bandages are best as they provide suffi cient support without


Avoid HARM Heat


Heat packs, hot baths and saunas are not recommended and should be avoided


Alcohol


Alcohol slows healing time and encourages swelling and bleeding


Running


Any form of exercise that may damage the injury further should be avoided


applying undue pressure on the injury.


Sprained joints should be put to use as soon as it is not too painful to do so, whereas strained muscles should be immobilised for a few days6


. The only


exception to this rule is with severe ankle sprains, where studies have found that ten days of immobilisation recovered normal ankle function more quickly than exercising the ankle soon after the injury.


It may be appropriate to advise patients on how to prevent sprains and strains. Wearing the correct footwear for different activities, warming up prior to exercise and cooling down after exercise are all ways to reduce the risk of developing a sprain or strain. Regular strengthening and fl exibility exercises can also help to prevent injury. Promoting a healthy, balanced diet will help patients to keep muscles strong6


.


Recovery time differs depending on the severity of the injury. After an ankle sprain, most people are able to walk a week or two after the injury and have complete movement of the ankle after six to eight weeks. Sporting activities can usually be resumed after eight to twelve weeks.


Muscle strains are a different story. The time taken to recovery varies greatly; many people cannot return to sports for several months after the injury. Problems such as pain, instability and intermittent swelling can continue for years after the initial strain6


. •


REFERENCES 1. Sport and Recreation Alliance. Available at : www.sportandrecreation.org.uk/ policy/research/reconomics [Accessed 9/9/15]


2. Sport and Recreation Alliance. Available at : www.sportandrecreation.org.uk/lob- bying-and-campaigning/sport-research/ UK-fact-fi gures [Accessed 9/9/15]


3. NHS Choices. Sports Injuries. 2015. Available at: www.nhs.uk/Conditions/ Sports-injuries/Pages/Symptoms.aspx [Accessed 9/9/15]


Massage


Like alcohol, massages may increase bleeding and swelling and are therefore not recommended


Elevation


With knee and ankle injuries the leg should be elevated with pillows underneath for support


20 - SCOTTISH PHARMACIST


4. NHS Choices. Back pain- prevention. 2015. Available at: www.nhs.uk/Condi- tions/Back-pain/Pages/Prevention.aspx [Accessed 9/9/15]


5. NICE Clinical Knowledge Summaries. Sprains and Strains. 2015. Avail- able at cks.nice.org.uk/sprains-and- strains#!backgroundsub [Accessed 10/9/15]


6. NHS Choices. Sprains and Strains. Avail- able at: www.nhs.uk/Conditions/Sprains/ Pages/Introduction.aspx [Accessed 10/9/15]


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