In the physio clinic we are frequently asked about how to manage the first few days of a soft tissue injury, such as an ankle sprain or strain. Most commonly people are asking should they use ice or heat and whether to rest or move? Keep reading if you'd like to understand why ice is no longer recommended.
Here is a clear guide, taken from evidence based guidelines produced by the British Journal of Sports Medicine, so you can be sure you're looking after yourself or correctly advising others how best to recover after an acute soft tissue injury.
What is a soft tissue injury?
Soft tissues include ligaments, muscles and tendons. These soft areas of the body can become injured after a trauma like a strain, sprain or overload.
After an injury your body works hard to repair, recover and renew the affected area. The process starts with inflammation which often causes:
pain in and around the area
There are a few things you can do to help this process and get back to your usual activities.
Protect and Elevate
Generally, the first few days are the worst with regards to pain and limitation of movement. You should listen to your body and adapt your lifestyle to suit. Prop your arm up to help a sore shoulder or elevate a sprained ankle higher than the heart, as often as possible.
Avoid anti-inflammatory medication
Evidence suggests medications like Ibuprofen have limited benefits and may in some cases slow down tissue healing if taken too early in your recovery. Stick to paracetamol if you need pain relief or speak to your doctor or pharmacist for further advice.
Using a tubigrip style bandage or sports compression sleeve can be a helpful way to manage significant swelling. Make sure the fit is right, enough compression to support but not too tight. You can combine compression with elevation of the injured limb.
Recent studies have now identified that the use of ice for acute soft tissue injuries is NO LONGER RECOMMENDED. It is safe to use for pain management but it can delay the start of the healing process.
The problem with using ice is that it is a vasoconstrictor, thus it limits blood supply and therefore swelling, but in turn that also limits the arrival of immune cells and thus interferes with that start of the healing process.
Do not use heat in the first few days of a soft tissue injury. If you do choose to use ice, never place it directly on your skin and use a barrier, like a damp tea towel, to protect your skin from a burn. Use the ice for around 15 minutes and apply every few hours.
*If you are diabetic or have diabetic neuropathy, or other issues with circulation or sensation you should not use ice.
Remember too much rest can slow down your recovery, as soon as you can start moving and using the affected area. You could use a walking aid to help you get around, if you've strained your calf muscle or ankle. Continue to stay within acceptable pain limits but remember you don’t need to be pain free. Aim to do a little bit more each day or every few days.
If the site of your injury becomes very painful, swelling worsens or the area becomes very red and hot, seek advice from a healthcare professional.
Repair, Restore and Renew
As your symptoms settle, the pain eases and your confidence to use the affected area grows, start to re-introduce normal activties, movement, strength exercises and functional activities.
All these actitvies and movements help reduce stiffness, pain and swelling. They also, most importantly, provide your body with the vital information and stimulation it needs to repair, restore and renew itself.
Most people can recover from a soft tissue injury by following the guidelines above. However if you sustained a nasty ankle sprain or perhaps your shoulder pain, after too much gardening, isn't settling and repairing, then do book in to see one of our physiotherapists. You might just need a bit of extra help to get back to normal, and we can provide that! Book in online here or call the clinic on 01932 645320 to book an appointment.