Sprains and strains: Management

Tennis elbow

Managing muscular sprains and strains

Fortunately, sprains and strains typically respond well to treatment.

Most injuries of this type will feel better after 2 weeks, although severe injuries may take several months to return to normal.1

Here we review the different approaches that could help your patient get back to enjoying their life.

Guideline recommendations for treating sprains and strains

Summary of NICE guidance on treating strains and sprains

Sprains and strains can be managed simply in the first 72 hours following the injury1

According to guidance from NICE, patients with sprains or strains should be advised to follow the PRICE protocol in the first few days after the injury.2

Read more about this approach below.

  • PRICE protocol

    PRICE protocol for sprains and strains

    PRICE stands for:2

    • Protection
    • Rest
    • Ice
    • Compression
    • Elevation
  • Woman with leg brace

    Protection

    • Protect from further injury (e.g. by using a support or high top, lace up shoes)2
  • Man reading with child

    Rest

    • For the first 48–72 hours after injury2
  • Man icing knee

    Ice

    • Apply ice wrapped in a damp towel for 15–20 minutes every 2–3 hours during the day for the first 48–72 hours after injury2. This should not be left on whilst the person is asleep.
  • Foot with compression wrap

    Compression

    • With a snug (not tight) elastic or tubular bandage, whilst the patient is awake2
  • Woman elevating leg

    Elevation

    • Keep the injured area raised and supported on a pillow until the swelling is controlled2
  • Man holding knee

    The PRICE protocol summarises how patients can take care of their sprain or strain in the first few days after the injury.

  • HARM protocol

    HARM protocol for sprains and strains

    HARM describes some key factors to avoid in the first 72 hours after injury:3

    • Heat
    • Alcohol
    • Running
    • Massage
  • Woman with heat pack

    Heat

    • Avoid heat sources as they encourage blood flow which will tend to increase bruising and inflammation.3
  • Avoid alcohol, which can increase bleeding and swelling and reduce healing

    Alcohol

    • Avoid alcohol, which can increase bleeding and swelling and reduce healing3
  • Man running on beach

    Running

    • Avoid running or other forms of exercise that can cause further damage3
  • Woman being massaged

    Massage

    • Avoid massage, which can increase bleeding and swelling3
  • Man with ankle pain

    The HARM protocol summarises what patients should avoid in the first 72 hours after injury if they have a sprain or strain.3

Man rubbing elbow

Analgesics can be used to relieve pain from sprains and strains

NICE guidance recommends advising on use of analgesia for symptom relief including cautions and contraindications:2

  • Paracetamol or a topical NSAID is recommended as first line
  • An oral NSAID may be used if needed
  • The short-term use of codeine as an ‘add on’ medication may be considered.

Utilising physical therapy to improve outcomes

Massage and exercise

Physiotherapeutic interventions can be beneficial for soft-tissue injuries

Treatment and rehabilitation plans must be individually tailored to maintain and improve range of motion, reduce pain and inflammation, and improve functional activities.2

For example, massage therapy can reduce stiffness and muscle soreness – although this should not be used in the first few days after the injury.

Using multimodal approaches to relieve pain from sprains and strains

Multimodal therapy

A multimodal strategy is helpful

NICE guidance recommends that pharmacological and physiotherapeutic interventions can be combined into a multimodal approach for managing sprains and strains.2

How can Dan be helped?

Dan

Dan

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Understanding sprains and strains

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Causes

Find out about the causes of sprains and strains.

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Signs and symptoms

Explore an overview of how to recognise sprains and strains and know when to refer patients.

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Overview of joint pain

Find out about joint pain and meet two patients with joint pain.

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Patient care resources

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