Sports injuries are NOT inevitable but, sadly, they are common. We believe that all athletes should have a basic knowledge of first aid but, even more importantly, they should understand and follow the relatively simple guidelines for injury management when and if injuries occur. A small amount of early care can often make the difference between being unable to compete for a week and being unable to compete for a month or even longer.
The most important time in the treatment of acute soft tissue injuries is the 24 hours immediately following injury.
Appropriate treatment at this time will limit the damage to the tissues and reduce the swelling, bleeding and pain that hinders recovery. Ultimately, this will result in less time spent away from your sport.
Injury Management Guidelines
The most appropriate method of treatment in the first 48 hours is summarised by the letters RICED.
Whenever possible, you should cease activity immediately following injury. Continued movement of the injured part will increase bleeding and swelling, and cause further damage to the tissues. The injured area should be rested as much as possible over the next 48 hours. In more serious cases, the injured part may need to be rested completely with the use of crutches or a sling.
The application of ice immediately after injury reduces the amount of pain, bleeding and swelling. Ice can be applied in a number of ways:
- Crushed ice wrapped in a damp towel
- Frozen gel packs
- Immersion of part in ice and water
NEVER APPLY ICE DIRECTLY TO THE SKIN AS THIS MAY CAUSE A BURN. Placing a damp towel or cloth between the skin and the ice will help prevent this.
Ice should be applied as soon as possible after the injury. The ice pack should be applied for 20 - 25 minutes every 2 hours. Leaving the pack on for longer can cause damage to the tissue. The skin should be checked under the ice pack after 2 or 3 minutes to make sure there are no signs of an ice burn (blistering).
Compression of the injured area with a firm bandage reduces bleeding and swelling. The bandage needs to be stretchable and should be applied firmly but not so tightly as to cause pain and should be applied both during and after ice application. Bandaging should be started just below the injury, with each layer of the bandage overlapping the underlying layer by half, and should extend to at least one hand's breadth above the injury.
Elevation of the injured part reduces blood flow to the injured area and so will limit the amount of swelling. It can be achieved by using a sling for upper limb injuries and by resting lower limbs on a chair, pillows or bucket. It is important to ensure that the lower limb is above the level of the pelvis.
Consult a medical professional (such as a doctor or physiotherapist) especially if you are worried about the injury, or if the pain or swelling gets worse. If the pain or swelling has not gone down significantly within 48 hours, also seek treatment.
What to avoid in the first 48 hours:
The acronym HARM is a great guideline of what should avoid in the first 48 hours after an injury.
You should not put heat on the area. Heat causes the blood vessels to dilate and allows more blood into the area, this increases the amount of swelling which then increases the amount of damage done and prolongs the injury. Heat in the form of Hot baths and Hot packs should be avoided.
Alcohol should not be consumed in the first 48hours after an injury. Alcohol also increases blood flow and causes more bleeding, swelling and damage. Alcohol also affects your balance and reduces your perception of pain, which means you may hurt yourself even more again increasing the amount of time that you aren’t able to play sport.
Running or any form of exercise will cause further damage immediately after an injury. Players should not resume exercise within 72 hours of an injury unless a medical professional says it is all right to exercise
Massage should be avoided in the first 72 hours. Massage causes an increase in bleeding and swelling, and should be avoided within the 72 hours of the injury. If the injury is massaged within the first 72 hours, it may take longer to heal.
When to apply heat
Heat can promote healing by increasing blood flow to the injured area, however, in the first 72 hours this will increase swelling and slow your recovery. Heat treatments may be started once swelling has subsided.
Hydration is a very important area of the dietary needs of anyone partaking in any exercise activities. It is important to get enough fluids before competition and training, but also it is important to re-hydrate after exercise to aid recovery.
A good way to monitor your hydration is by checking the colour or your urine. Thirst is a poor indicator of hydration. By the time you’re thirsty you are already dehydrated. So when you go to the loo, have a look at the colour of your urine. A large amount of light colored, diluted urine probably means you are hydrated; dark colored, concentrated urine probably means you are dehydrated and need to drink more.
The ideal replacement fluid consists mostly of water, sports drinks can be useful but simple water is more than sufficient. The temperature of the fluid should be cool not warm, as this enables more rapid movement of the fluid out of the stomach. If a game, training, performance is in the heat or is going to last for an extended period, try and find some way of replacing the fluid as you exercise (every 15-20 minutes). If that is not possible, you must aim to be well hydrated prior to exercise (a couple of glasses of water 15-20 minutes prior to exercise), and to replace the fluid as soon as possible after exercise.
- Seek treatment at an early stage
- Ensure you physiotherapist provides you with methods of self treatment and management.