The first modality for sprains, strains and tendonitis can be remembered using the acronym RICE. The treatment of sprains depends on the extent of injury and the joint involved. Medications likenon-steroidal anti-inflammatory drugs can relieve pain. Topical NSAIDs appear to be as good as those taken by mouth.
- Rest: The sprain should be rested. No additional force should be applied on site of the sprain. In case of, for example, a sprained ankle, walking should be kept to a minimum.
- Ice: Ice should be applied immediately to the sprain to reduce swelling and pain. It can be applied for 10–15 minutes at a time (longer application of ice may cause damage instead of healing), 3-4 times a day. Ice can be combined with a wrapping to minimize swelling and provide support.
- Compression: Dressings, bandages, or ace-wraps should be used to immobilize the sprain and provide support. When wrapping the injury, more pressure should be applied at the far end of the injury and decrease in the direction of the heart; the reason for this is that it more easily causes unnecessary fluid to be flushed back up the blood stream in order to be recycled. Compression should not cut off the circulation of the limb.
- Elevation: Keeping the sprained joint elevated (in relation to the rest of the body) will also help minimize swelling.
Ice and compression (cold compression therapy) will not completely stop swelling and pain, but will help to minimize them as the sprain begins to heal itself. Careful management of swelling is critical to the healing process as additional fluid may pool in the sprained area.
The joint should be exercised again fairly soon, in milder cases from 1 to 3 days after injury. Special exercises are sometimes needed in order to regain strength and help reduce the risk of ongoing problems. The joint may need to be supported by taping or bracing, helping protect it from re-injury.
Functional rehabilitation
Prolonged immobilization delays the healing of a sprain, as it usually leads to muscle atrophy and stiff joint. The components of an effective rehabilitation for all sprain injuries include increasing range of motion and progressive muscle strengthening exercise. These should be taken care of without delay.
Physical therapy, occupational therapy, orthotics or braces may also be useful for tendonitis. Initial recovery is typically within 2 to 3 days and full recovery is within 3 to 6 months. Tendinosis occurs as the acute phase of healing has ended (6–8 weeks) but has left the area insufficiently healed. Treatment of tendinitis helps reduce some of the risks of developing tendinosis, which takes longer to heal.
Steroid injections have not been shown to have long term benefits but have been shown to be more effective than NSAIDs in the short term for tendonitis.
In chronic tendinitis or tendonosis laser therapy has been found to be better than conservative treatment at reducing pain; however, no other outcomes were assessed. Both prolotherapy and PRP injections are being used more frequently with good clinical short and long term outcomes in tendonosis - research has been only slightly positive for these treatment modalities due to the poor design of many of the completed studies.
