Sprains,
Strains, and Automobiles
I truly don’t know of any individual that I have encountered
who has not had a sprain or strain of the finger, wrist, ankle,
toe, or any of the joints, especially when doing some type
of excursion in the outdoors. The ground is not a flat, even
plane and there are always hills, valleys and rocks in our
way. Many times we are involved in a beautiful sight or an
activity and not paying attention to the ground. This frequently
results in tumbles and spills which result in sprained ankles
and strained toes, along with sprained and strained wrists
and fingers.
Signs
and Symptoms
A
sprain is defined by the twisting of a joint out of its normal
range of motion to a point that causes pain and usually involves
swelling. These can involve fractures. A strain is usually
caused by a pulling or pushing motion and generally involves
a tendon or muscle group. These also can include fractures,
but rarely. For the sake of brevity, we are not going to list
all the joints that are involved in sprains and strains. However
the most common are the knees and ankles, and there are a
set of rules, called the Ottawa rules, that will help you
as a layperson diagnose whether or not you may or may not
have a fracture to a knee or ankle. Please refer to Survive
Outdoors.com and look at fractured ankles and knees for Ottawa
rules.
Treatment
It is
a myth that individuals who sprain an ankle should not remove
their shoe. Shoes and socks must be removed from both feet
when a sprained ankle is suspected. This is important because
we have two extremities, two arms, two hands, two ankles and
two feet, and we need to compare the injured area to the normal,
comparing the amount of swelling and color. Is the injured
area getting blood flow past the injured point? Is there sensation
past the point of injury? Once a comparison is made, if there
is any deformity and you are long way from getting back to
a healthcare provider, attempts should be made to try to put
the foot, finger, or wrist back in place, to normal anatomical
position. Studies have shown this to be more effective and
chances of causing damage down the road are far less, especially
if you have a 2-3 day trek back to a healthcare provider.
At that point, it is very important to immobilize and splint
the area. There are a multitude of instruments that can be
used for splinting. We have talked about this under first
aid tips, anything from fishing rods to sticks to gun barrels.
The SAM splint is lightweight and useful to carry in your
pack. Once immobilized, if there is ice available, that would
be very helpful. Elevate the area above the heart to decrease
swelling. This is of the utmost importance as increased swelling
causes more pain. Next is where the automobile comes in—the
injured individual needs to be transported to a healthcare
provider for assessment and x-ray if fracture or dislocation
is suspected.
Ice or
warmth? This question has been asked numerous times. Ice should
be used for sprains and strains in the first 24-48 hours.
After that, wet warmth. Ice, vaso-constricts and wet warmth
vaso-dilates. So we are going to first use ice for the first
24-48 hours, elevate to decrease swelling and after that point,
wet warmth has proved to be helpful.
Also in
our outdoor first aid kit, I will carry Tylenol and Advil.
It is totally safe to take three 200 mg. Ibuprofen as well
as two Tylenol or Acetaminophen every 6-8 hours for moderate
pain relief in an outdoor setting when nothing stronger is
available.
Makeshift
crutches are nice to have, to help relieve pressure on the
extremity and to aid in walking.
Also remember
when assessing your sprain and strains and treating them,
please look for abrasions or bleeding which many times indicates
a fracture. An open fracture means the skin is broken and
the bone is fractured. That doesn’t mean that the bone
has to be sticking out of the skin. These are medical emergencies
and the individual needs to be transported, and antibiotics
need to be administered.
Good luck,
walk smoothly and tread softly on Mother Earth.
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