Sprains

One second you were walking, the next you were sprawled on the ground. At first only your dignity seemed the worse for wear. But as you began to collect yourself, you noticed intense pain gripping your ankle. You could barely stand up, much less walle Then your ankle began to swell. That's when you realized that you might have a sprain.

People tend to use the term sprain to refer to any painful joint injury. But a sprain is actually a torn ligament, says Anne Simons, M.D. Ligaments are fibrous, elastic bands of connective tissue that attach bones to one another.

You can tear a ligament in any number of ways: overturning your ankle as you step off a curb, wrenching your knee during a pickup game of basketball, or twisting your wrist as you try to break a fall.

Some research suggests that sprains may be stress-related. Stress increases muscle tension, and tense muscles don't allow joints to move as they should. Plus, stress can be distracting, so you may not be as careful to avoid situations that can lead to sprains.

Not all sprains are created equal, however. In mild sprains, fewer than 25 percent of the ligament fibers tear. In moderate sprains, 25 to 75 percent of the ligament fibers tear. But if you have a severe sprain, more than three-quarters of the ligament fibers have been torn.

All sprains produce the same telltale symptoms: sudden sharp pain in the affected joint, followed by swelling. While the swelling will usually subside within a week, don't be surprised if the pain lasts a lot longer. And even after the pain goes away, you may feel so stiff that you have to limit your movements until the damaged ligament completely mends.

For a lot of pain and swelling, you will want to see your doctor-particularly if you think there might be a fracture. But if it's a mild to moderate sprain, you can treat it on your own, following a blended approach.

Best Choices

Supplements

Boost healing with bromelain. An enzyme found in pineapple, bromelain has potent anti-inflammatory properties. "There's good evidence that bromelain can help treat sprains and other musculoskeletal injuries," says Alan Gaby, M.D.

Joseph Pizzorno Jr., N.D., recommends taking 450 milligrams three times a day before meals.

Exercise

Build better muscles. "Successful healing of a sprain depends on controlling inflammation plus conditioning the muscles around the injury," says Francis O'Connor, M.D., director of the primary-care sports­medicine fellowship at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. By "conditioning," Dr. O'Connor means exercising your muscles in ways that stretch and strengthen them.

Herbal Medicine

Try bark with a bite. The herb willow bark contains salicin, which is a chemical forerunner of aspirin. To make willow bark tea, add about 2 teaspoons of powdered herb to 1 cup of boiling water. Simmer for 10 minutes, then strain. Allow the tea to cool before drinking it.

Get help from hawthorn. According to Dr. Pizzorno, hawthorn contains compounds that help stabilize collagen, the protein that's responsible for maintaining the integrity of ligaments and tendons. He recommends taking 2 teaspoons of standardized hawthorn tincture three times a day. You can take hawthorn for 3 to 4 weeks.

Home Remedies

At First, rely on RICE. RICE stands for rest, ice, compression, and elevation. It's standard first-aid for sprains, says Steven Subotnick, D.P.M., a sports-medicine specialist in San Leandro, California, and author of Sports and Exercise Injuries. Here are the guidelines.

  • Rest: At the first sign of pain, stop what you're doing. Then for the next few days, use the injured joint as little as possible. As your pain subsides, slowly ease your joint back into action. For example, take slow, short walks to mobilize a sprained ankle or knee.
  • Ice: Apply an ice pack to the injured joint for 20 minutes every few hours. The cold helps reduce swelling and inflammation.

    Never apply ice directly to your skin, cautions Bryant A. Stamford, Ph.D., director of the Health Promotion and Wellness Center at the University of Louisville in Kentucky. It can actually cause frostbite. Instead, wrap the pack in a towel or lay a towel between the pack and your skin.

  • Compression: When you're not applying an ice pack, wrap the injured joint with an elastic bandage. This reduces swelling and helps minimize your discomfort as your joint heals. Keep using the bandage for several days.
  • Elevation: To regulate the flow of blood to the site of the sprain, raise the injured joint above the level of your heart. Later on, switch to heat. Once your swelling has begun to subside, replace the ice packs with heat. You can soak the affected joint in tolerably hot water or apply a heated gel pack.

Over-The-Counter Drugs

Pick the right pills. To relieve the pain and inflammation of a sprain, take aspirin or ibuprofen rather than acetaminophen. Acetaminophen relieves pain, too. But unlike aspirin and ibuprofen, it doesn't have anti-inflammatory action, so it won't reduce swelling.

If aspirin upsets your stomach, choose enteric-coated capsules or tablets. They are gentler on your stomach.

Other Good Choices

Massage

Rub yourself for relief. After the initial pain has subsided, Dr. Subotnick suggests lightly massaging the injured joint for 10 minutes twice a day. Massage stimulates blood circulation through the affected area, which promotes healing.

Aromatherapy

Apply essential oils. To make your self­massage even more therapeutic, try using healing essential oils. Kathi Keville and Mindy Green, coauthors of Aromatherapy: A ComPlete Guide to the Healing Art, suggest making your own massage lotion or oil with the following: 6 drops of helichrysum, 4 drops of marjoram, 4 drops of birch, 3 drops of chamomile, 3 drops of lavender, 3 drops of ginger, and 2 drops of juniper. Add all of these essential oils to 2 ounces of unscented lotion or vegetable oil. Then rub the lotion or oil into your skin as part of your self-massage.

Homeopathy

Take three steps toward healing. According to Dr. Subotnick, homeopaths follow a three-step approach to treating sprains. They start with medicines that undo the trauma of a sprain. Then they switch to medicines that support the healing process. Next, they prescribe medicines that help prevent reinjury.

During the first 24 hours after a sprain, Dr. Subotnick recommends taking one of the following homeopathic medicines. Choose the one that most closely matches your symptoms.

  • Arnica, if ice packs relieve your pain
  • Sulfuricum acidum, if Arnica helps only a little
  • Bellis, if you can't tolerate ice packs and prefer heat
  • Bryonia, if you're having difficulty moving the affected joint.
  • Ledum, if you often have sprains
  • Phytolacca, if rest and elevation help signillcantly
  • Stellaria, if rest and motion cause pain

Take the medicine in the 6th, 12th, 15th, or 30th potency. If you don't notice any improvement in your symptoms within 2 hours, try another medicine. When you find one that helps, take it once or twice a day until your symptoms subside.

At that point, Dr. Subotnick says, you should start taking a medicine that promotes recovery. From the following list, choose the medicine that most closely matches your symptoms.

  • Rhus toxicodendron, if the injured joint feels stiff in the morning, if massage and warmth help, and if you feel restless
  • Ruta graveolens, if gentle movement helps, and if you worry about your injury ("Will I ever get better?")
  • Phytolacca, if rest continues to feel better than motion
  • Bryonia, if your swelling is slow to subside and it feels better with continued compression

Take the medicine in the 6th, 12th, 30th, or 200th potency once a day for 3 or 4 days. After that, begin taking Calcarea phosphorica in the 12th or 30th potency twice a day for 2 weeks. Calc phosphoric a can help protect your joint against reinjury.

Chinese Medicine

Stop Blood from stagnating. "Here's a case where Chinese medicine advises doing the opposite of what Western medicine advocates," says Efrem Korngold, O.M.D., L.Ac. "In Western medicine, you're told to ice the injury. But the Chinese alternate ice and heat-the ice to prevent swelling, the heat to stimulate Blood circulation."

In addition, Chinese physicians prescribe topical application of herbs that expel Cold, Wind, and Damp, such as clematis root, gentian root, chaenomeles fruit, and dried ginger. They may also recommend herbs that can get Blood moving, such as cinnamon twig, peppermint oil, camphor, and red pepper.

Try needle treatment. Acupuncture can stimulate healing of a sprain. Which points the acupuncturist uses depends on which joint you have injured. "If you have a sprained right knee, an acupuncturist would likely insert needles in your left knee, then burn moxa (mugwort) over the affected knee," Dr. Korngold says. This procedure, called moxibustion, is intended to draw out Cold, Wind, and Damp and stimulate circulation.

Consider bleeding and cupping. There are two other procedures that an oriental medicine doctor may use in conjunction with acupuncture to draw out external forces such as Cold, Wind, and Damp. They're called bleeding and cupping. "Chinese bleeding is much different from the bloodletting that Western medicine practiced centuries ago," Dr. Korngold says. "The Chinese use tiny pinpricks, so actual blood loss is negligible."

Cupping involves burning alcohol-soaked cotton in small jars. When the fire dies out, the practitioner places the jar mouth-down over the affected area. The fire reduces the air pressure in the jar, so when the jar is placed against your skin, your skin gets sucked up inside. This is believed to draw out Cold, Wind, and Damp. If performed by a qualilled oriental medicine doctor, both bleeding and cupping are considered safe and useful.

Ayurvedic Medicine

Make a turmeric paste. The spice turmeric has potent anti-inflammatory properties. For this reason, it's an effective topical treatment for sprains, says Vasant Lad, B.A.M.S., M.A.Sc., director of the Ayurvedic Institute in Albuquerque, New Mexico.

He suggests combining one part salt and two parts turmeric with enough water to create a paste. Apply the paste to the affected joint and cover with a cloth. Leave on the paste for 20 minutes to an hour, then rinse it off. Repeat once a day until your joint feels better.

Turmeric can stain fabric as well as your skin. During treatment, use an old cloth that you won't mind discarding. To protect your clothing, make sure that the cloth fully covers the paste. But don't worry about the discoloration of your skin. Once you stop the treatment, your skin color should return to normal within 2 weeks, Dr. Lad says.

Medical Measures

Until recently, doctors often used splints or casts to immobilize moderate to severe sprains. But studies have shown that muscles around the torn ligament get weakened if the joint is immobilized for a long time.

If your doctor wants you to wear a splint or cast, ask for how long. Ideally, your joint should be immobilized for only a few days, until the pain and swelling begin to subside, says John Connolly, M.D., clinical professor of orthopedic surgery and rehabilitation at the University of Miami School of Medicine. Then you should begin doing gentle exercises, with a goal of getting the joint into better shape within a week or so.

If you have a really bad sprain, your doctor may recommend surgery to repair the torn ligament. Or you may need physical therapy to strengthen the muscles around the ligament.

If you've experienced multiple foot, ankle, or knee sprains in your lifetime, consider consulting a podiatrist. You may have a foot abnormality that can be corrected with custommade shoe inserts, called orthotics.

Red Flags

If your joint pain is accompanied by fever, chills, or night sweats, or if there's a break in your skin near the affected joint, see your doctor right away. You may have an infection. Also see your doctor immediately if you have swelling but don't recall injuring yourself.

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