First aid for sprain

Some clinical features of a sprain can include:

• A popping sound or sensation at the time of injury
• Pain in the affected joint or limb
• Swelling of the affected joint 
• Bruising in the affected area 
• Joint instability
• Difficulty bearing weight on the limb supported by the joint affected
• Decreased functional ability of injured joint
• Reduced range of motion of the injured joint

Signs and symptoms that require emergency hospital treatment:

• Numbness or loss of sensation in the injured joint
• Complete inability to move the joint 
• Repeat injury to a joint that was previously injured once or more than once
• Severe pain that is intolerable and uncontrollable even with NSAIDs

Sprains are indistinguishable from other injuries like fractures or tendon ruptures without an X-ray. Therefore, it is important to give the correct first aid to avoid causing more serious complications, like nerve injuries, if the injury turns out to be due to another cause.

Steps to follow while giving first aid for a suspected sprain can be remembered as P.R.I.C.E. and are described below: 

• Protect: To avoid the affected joint and limb from getting injured further and keeping it immobilised, appropriate support, a splint or a sling can be used. 
• Rest: Following a sprain, weight should not be borne by the affected joint and limb for at least 2 to 3 days.
  • This will keep the swelling and pain down. 
  • Bed rest is not mandatory, especially if the sprain is in an upper limb.
  • Mild exercise or activity that does not involve the injured joint is permitted. 
• Ice: The application of clean ice packs or a clean cloth dipped in cold water can help keep swelling, pain and redness down.
  • Start cold compresses as soon after the injury as possible.
  • Continue to ice a sprain for 15 to 20 minutes, four to eight times a day, for the first 48 hours or until swelling improves.
• Compression: The affected joint should be wrapped with an elastic wrap or bandage as soon as possible. Compressive wraps or sleeves made from neoprene can also be used; they slide on and off much more easily.
• Elevate: As the injured limb will be kept immobilised for the first few days, swelling and edema can develop. By keeping the limb elevated passively, like with a comfortable pillow placed under an injured ankle, while resting, swelling can be prevented. 

Over-the-counter painkillers like acetaminophen or ibuprofen can be taken for managing pain.

Most sprains are minor injuries and heal spontaneously with good conservative care at home. The P.R.I.C.E. (Protect, Rest, Ice, Compression, Elevate) treatment should be used for the first 2 to 3 days after a sprain. However, it is advisable to get an X-ray or an orthopaedic consultation to rule out a more serious injury like a fracture. Usually, the more severe the pain associated with a sprain, the more serious the injury is.

• It is advisable to get the injury evaluated by a doctor and an X-ray, especially if the pain is considerable. In case of a severely painful sprain, a complete ligament tear is suspected.
• An MRI will be needed to assess the extent of the ligament tear in such cases.
• A moderate sprain with a partial ligament tear may need bracing to allow for the healing of the partial ligament tear. The location and extent of the injury will determine how long a brace is needed.
• A severe sprain with a complete ligament tear may require surgery to repair the ligament. A commonly torn ligament is the anterior cruciate ligament (ACL) of the knee.

(Read more: Knee sprain)

It can take days to months to recover from a sprain. The joint may sometimes never fully heal and be prone to reinjury. The first 3 days after a sprain injury, P.R.I.C.E. treatment should be done at home. Painkillers should be taken when the pain is immense. NSAIDs should only be taken after a gap of 6 hours from the previous dose. Exercise should be continued and the injured limb should slowly be reintegrated into activities. It is important to restore strength and stability to the injured limb prior to a return to sports or fitness activities. Physiotherapy may be needed.

Usually, sprains heal spontaneously with adequate care at home. Sometimes, complications can occur, including:

• Chronic instability of joint 
• Loss of function of joint – usually partial
• Chronic pain in the joint 
• Chronic swelling of joint 
• Nerve injuries – usually resolve but can persist
• Recurrence of injury to the same ligament

(Read more: Muscle strain)