RICEM

After any injury it is usually necessary to REST the injured area for 2–3 days. This means avoiding use of this area, e.g. if you sprain an ankle then you would want to limit your walking and also walk with a limp, if necessary, so as to minimise pain or discomfort and reduce the chance of aggravating it further. You should try to return to normal walking as soon as possible. If you are unable to do so it is a sign that you need to walk only short distances and then rest and you should see a physiotherapist for an assessment. Additionally, with some injuries it may be necessary to bandage, strap or boot the ankle to further reduce the chance of further injury and to limit the amount of inflammation.

To complicate this however is a certain case of pain and discomfort called Delayed Onset Muscle Soreness (DOMs). DOMs is related to completing an exercise which the body is unconditioned for, e.g struggling with a pushchair up a large hill, the first episode of weeding the garden, the first run after a lay-off, the first game of the season etc. It is usually felt 2–3 days following completion of the unaccustomed exercise and settles within a week or so. This type of soreness actually likes gentle exercise, such as swimming or cycling and gentle massage and sometimes stretching.

After any episode of discomfort, pain or injury (DPI) it is usually beneficial to apply ice for the first 48-72 hours to the affected area. The ice should ideally be crushed within a plastic bag or towel and lightly fixed to the injured area for 20 minutes every 2 hours. If pain or burning is felt it should be removed and not continued if the skin remains red and painful. If the skin is ok, then a barrier cream (moisturising cream or Vaseline) should be applied prior to the next icing. For superficial injuries an ice massage may be advantageous. To do this place an ice cube on the skin directly or first apply a cream or oil if you feel any burning sensation. Use a flannel to protect your finger tips as you massage the ice over the affected area. Make sure that you keep the ice moving as keeping it still will increase chance of a burn. Ice massage for 2-5 minutes and up to 5 x per day.

After an injury the affected area should be compressed, either by an elastic bandage or an elastic stocking. This should be applied as firm as possible to help prevent further bleeding and inflammation and also help protect the injured area. The bandage must be removed however, if it causes increased pain, discoloration, numbness, or pains and needles. The compression should be continued until the swelling has subsided but should usually be removed at night.

After an injury the affected area should be elevated above the level of the next joint back i.e foot above the knee, for an ankle injury or knee above the hip, for a knee injury etc. Maximal elevation can be applied as tolerated also, i.e. the foot above the knee and knee above the hip, for an ankle injury. The elevation should be continued as much as practical until the swelling has subsided. Swelling in the leg or lower arm will be more apparent during the day: as a result of gravity. Elevation will be best later in the day to counter this affect. Lying on the floor with a foot up the wall for 30 minutes plus, in the afternoon or evening, will greatly assist reducing ankle swelling.

24–48 hours after an injury the area should be encouraged to move very gently through some part of its range of movement – this painfree range should then gradually increase each day as healing occurs. If this does not occur then you should definitely see your physiotherapist for an assessment.