Strains sprains and the RICE procedure

One injury you may come across is when someone has fallen badly and suffered from a strain or a sprain.

A sprain happens when muscle is overstretched or torn or where a tendon is connected to muscle. A common area to be sprained is the ankle.

A strain is where the ligament is stretched or torn, usually where there's been a sudden wrenching motion as the joint has been forced apart, damaging surrounding tissues. Common locations on the body for strains are the lower back or hamstrings.

Ligaments hold joints together and tendons attach the muscles to the bone. Another injury could be where muscle is torn. A typical example of this is a hamstring injury in the leg where muscle fibres get torn, causing severe pain and swelling.

The main difference is that with a sprain you will have bruising around the joint. With a strain, you may have spasms in the affected area. With both, you may have pain, swelling, and limited movement.

The first aid treatment for strains and sprains is the same, so it's not that important that you identify what they are suffering from. The treatment we give is to try and reduce the swelling and pain.

The treatment is easy to remember with the acronym RICE. R, rest the limb. I, apply ice to the limb to reduce the swelling. C, Provide Comfortable support. E, elevate the limb to reduce swelling. Now we will look at each of these points in more detail.

First, make sure the scene is safe and the patient cannot come to any further harm.

R - Rest. The first thing to do is to sit the person down or help them to sit or lay in a comfortable position. Keep the injured limb in a comfortable place supported, ideally elevated.

I - Ice. Next, we need to cool the area using an ice pack, a cool pad or a chemical instant ice pack that has crystals in liquid. You squeeze it to break the liquid, shake it, and the resulting reaction will cool the pack down. Do not put ice or cool packs directly on the skin as this can burn the patient. Wrap it in a tea cloth or a triangular bandage to avoid direct contact with the skin.

C - Provide Comfortable support. With this, you need to apply soft padding over the area and bandage using a conforming or crepe bandage. This is done over the cold compress to hold it in place. Do not apply this too tight, as this can because more pain and discomfort. Make sure it’s not too tight by checking their circulation every 10 minutes. This can be done with a capillary refill check pushing on the skin past the injured area for five seconds until it goes pale. If the colour doesn’t come back within two seconds, loosen and reapply the bandage. It may also be an indication of a more serious injury that needs professional assistance.

Finally, E - elevate. Here we need to elevate the limb to reduce the swelling. This could be on pillows, a bag or a chair.

The next problem you have is whether to move the patient or not. In the case of a wrist or an arm, you can usually put the arm in a horizontal sling and move them quite easily once initial treatment has taken place. Help them to their feet and walk them to get professional help. But take care, as it may be they are in a lot of pain and they may feel faint, so let them get up slowly and give them help when needed.

If they have a leg or ankle problem, moving them may be very difficult and you may need to call for help. The person will not be able to put weight on the area, so you must make sure that you do not accidentally get them to stand on it. If they are moved, once the limb is no longer elevated, swelling and pain can increase. It may be that you could help them to hop to a place of safety. If not, stay with them until help arrives.

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