Treatments: Functional rehabilitation
R.I.C.E. stands for rest, ice, compression and elevation. This is often the first step for all but acute injuires.
Cold therapy (also called cryotherapy), uses a cold bath or ice that decreases sensitivity of painful areas and relaxes muscle spasms. The cold slows nerve impulses to the muscle and decreases blood circulation which helps reduce inflammation.
Heat therapy relaxes muscles, relieves pain and accelerates healing by increasing blood flow to a targeted area. Application of heat has many forms, from simply taking a hot shower to sophisticated methods such as ultrasound. Heat should not be used immediately after injury but after swelling has gone down.
Hydrotherapy can include cold or hot baths – or alternating them, which is called contrast bathing. The theory on the effectiveness of contrast baths is that the changes between vasodilation (heat) and vasoconstriction (cold) cause a pumping action in the muscles and helps speed waste removal and nutrient delivery. Whirlpool baths can promote muscle relaxation and sooth sensory nerve endings.
Therapeutic exercise can help restore muscle tone, strength and function and may include isometric, stretching and strengthening and range-of-motion exercises.
Therapeutic ultrasound sends vibrating impulses through tissues. The high frequency waves produce deep heat as well as a “micro massage” of tissues to increase blood circulation and enhance muscle relaxation. Ultrasound may be used with cortisone cream in a process called phonophoresis to help decrease acute inflammation.
Transcutaneous Electrical Nerve Stimulation (TENS) is a method of nerve stimulation. Electrodes are placed on the skin near the area of pain and connected to a small, battery-powered TENS unit. The low level of electrical current is believed to work by stimulating the release of endorphins or by blocking pain impulses. This treatment is commonly done at home.
Immobilization with casts, splints or braces is common for fractures but may be used for other injuries as well. A plaster or fiberglass cast is the most common type of fracture treatment because its rigid construction keeps the broken bone in proper position while it heals. Functional casts or braces allows limited or “controlled” movement of nearby joints and can be used for some fractures. There are a wide variety of collars, binders, belts, braces and other devices designed to offer relief from pain caused by sprains and strains.
First Aid for Injuries
Provide first aid immediately after an injury. A delay of a few hours will greatly reduce the effectiveness of care and delay an athletes return to activity. First aid care requires the application of:
R.I.C.E. should be applied for the first 72 hours after an injury.
Immobilize the injured area. For a hand or arm, this may involve not moving the area and/or using a sling or splint. Injuries to a leg will require crutches and/or an immobilizer brace for protection or assistance while walking.
- Apply a wet towel or ace bandage/elastic wrap (see “compression” for application).
- Place a one-gallon plastic bag with crushed ice (or cubes with water) over the bandage/elastic wrap.
- If directed by a health care professional, ice (not reusable ice) may be placed directly on the skin.
- Hold the ice in position with a bandage.
- Maintain ice application for 30 minutes and then remove the ice for 1 to 2 hours before re-applying the ice.
- The application of ice on and off the injured area should continue as many times as possible during the first 24 hours after injury.
- After 24 to 72 hours, the application of ice can be reduced to every 2 to 4 hours.
Maintain comfortable firm pressure with a bandage/elastic wrap at all times during and after icing to an area about 6 inches above and below the injured area. When applying the bandage/elastic wrap, start below and finish above the injured area. Remove the bandage/elastic wrap at night and reapply the next morning.
Whenever possible, the injured area should be maintained in a position above or level with the heart. Leg injuries will require elevation upon a chair with pillows. Arm injuries will require resting the arm level with the chest.
- If the body part becomes blue and/or loses sensation, remove the bandage/elastic wrap and ice. Then lower the limb.
- Never leave the ice on for more than 30 minutes.
- If crutches are not available for a leg injury, be sure to have someone assist you so that you do not put weight on the injured leg.
- Never use heat directly after injury.
- If the symptoms from an injury do not improve, contact your physician.
How to Use Crutches, Canes and Walkers
If you ever break a bone in your leg or foot, have a surgical procedure on your lower limb or suffer a stroke, you may need to use crutches, a cane or a walker. In the beginning, everything you do may seem difficult, but with a few tips and some practice, you will gain confidence and learn to use your walking aid safely.
If an injury or surgical procedure requires you to keep your weight fof your leg or foot, you may have to use crutches. The top of your crutches should reach to 1-1 1/2 inches below your armpits while you stand up straight. The handgrips of the crutches should be even with the top of your hip line. Your elbows should bend a bit when you use the handgrips. Hold the top of the crutches tightly to your sides, and use your hands to absorb the weight. Don’t let the tops of the crutches press into your armpits.
Lean forward slightly and put your crutches about one foot ahead of you. Begin your step as if you were going to use the injured foot or leg, but shift your weight to the crutches instead of the injured foot. Your body swings forward between the crutches. Finish the step normally with your non-injured leg. When the non-injured leg is on the ground, move your crutches ahead in preparation for the next step. Keep focused on where you are walking, not on your feet.
Back up to a sturdy chair. Put your injured foot in front of you and both crutches in one hand. Use the other hand to feel for the seat of your chair. Slowly lower yourself into it. Lean your crutches upside down in a handy location. (Crutches tend to fall over when they are stood on their tips.) To stand up, inch yourself to the front of the chair. Hold both crutches in the hand on your good leg side. Push yourself up and stand on the good leg.
To walk up and down stairs with crutches, you need to be both strong and flexible. Facing the stairway, hold the handrail with one hand and tuck both crutches under your armpit on the other side. When you’re going up, lead with your good foot, keeping the injured foot raised behind you. When you’re going down, hold your injured foot up in front, and hop down each stair on your good foot. Take it one step at a time. You may want someone to help you, at least at first. If you’re facing a stairway with no handrails, use the crutches under both arms and hop up or down each step on your good leg, using more strength. An easier way is to sit on the stairs and inch yourself up and down each step. Start by sitting on the lowest stair with your injured leg out in front. Hold both crutches flat against the stairs in your opposite hand. Scoot your bottom up to the next step, using your free hand and good leg for support. Face the same direction when you go down the stairs this way. (back to top)
You may find it helpful to use a cane if you have a small problem with balance or instability, a minor weakness in your leg or trunk, an injury or pain. If you are elderly, a single point cane may also help you to keep living independently. The top of your cane should reach to the crease in your wrist when you stand up straight. Your elbow should bend a bit when you hold your cane. Hold the cane in the hand opposite the side that needs support.
When you walk, the cane and your injured leg swing and strike the ground at the same time. To start, position your cane about one small stride ahead and step off on your injured leg. Finish the step with your normal leg. To climb stairs, grasp the handrail (if possible) and step up on your good leg first, with your cane in the hand opposite the injured leg. Then step up on the injured leg. To come down stairs, put your cane on the step first, then your injured leg, and finally the good leg, which carries your body weight. (back to top)
If you’ve had total knee or hip joint replacement surgery, or you have another significant problem, you may need more help with balance and walking than you can get with crutches or a cane. A pickup walker with four solid prongs on the bottom may give you the most stability. It lets you keep all or some of your weight off your lower body as you take your steps. You use your arms to support some of the weight. The top of your walker should match the crease in your wrist when you stand up straight. Don’t hurry when you use a walker. As your strength and endurance get better, you may gradually be able to carry more weight in your legs.
First, put your walker about one step ahead of you, making sure the legs of your walker are level to the ground. With both hands, grip the top of the walker for support and walk into it, stepping off on your injured leg. Touch the heel of this foot to the ground first, then flatten the foot and finally lift the toes off the ground as you complete your step with your good leg. Don’t step all the way to the front bar of your walker. Take small steps when you turn. To sit, back up until your legs touch the chair. Reach back to feel the seat before you sit. To get up from a chair, push yourself up and grasp the walker’s grips. Make sure the rubber tips on your walker’s legs stay in good shape. Never try to climb stairs or use an escalator with your walker.
Other general guidelines for using walking aids around the house include
- Remove scatter rugs, electrical cords, spills and anything else that may cause you to fall.
- In the bathroom, use non-slip bath mats, grab bars, a raised toilet seat and a shower tub seat.
- Simplify your household to keep the items you need handy and everything else out of the way.
- Use a backpack, fanny pack, apron or briefcase to help you carry things around.