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2017 HCHB_digital

Strains and Sprains

Strains and Sprains Sprains and strains are common injuries, especially in children and people who play sport. A sprain comes from an immediate injury and pain usually occurs straight away or the injured person may report a pop, tear, or sudden loss of power. Pain from strains may not begin until a few hours after exercise. Swelling is usually greater with sprains and it can be difficult to move or walk on the injured part. Bruising may occur with either injury. Sprains A sprain can be a serious injury and occurs when a ligament is stretched and/ or torn. Ligaments are fibrous bands of connective tissue that join one end of a bone to another. Ligaments stabilise and support the body’s joints. Signs of a sprain include pain, swelling, bruising, instability, and loss of the ability to move and use the joint (called functional ability). Signs and symptoms can vary in intensity and with a mild sprain, minimal pain and swelling and little or no loss of functional ability is experienced. Sprains typically occur through direct or indirect trauma such as a fall, awkward landing or blow to the body. It knocks the joint out of position, overstretching and, in severe cases, rupturing the supporting ligaments. Ankles, wrists and knees sprain easily. If a sprain does not heal fully, there is a good chance the same injury will recur. Customers with a sprain should follow the RICED regimen for the first 48 hours (see opposite text box). Always refer customers with a moderate or severe sprain to a doctor or physiotherapist for further evaluation. Strains A strain is when the muscle or tendon (fibrous cord of tissue that attaches the muscle to the bone) has been stretched too far. Strains often happen when too much pressure is exerted on a muscle or the muscle is pushed too far (eg, when lifting a heavy object). Strains can happen suddenly or develop over a period of time. People with strains typically experience pain, limited motion, muscle spasms and, sometimes, muscle weakness. There may also be swelling around the affected area, cramping, or inflammation and some loss of muscle function. Severe strains are often very painful and disabling. Back, necks and legs can commonly be strained, especially if no proper warm-up has been done, or when somebody returns to a sport after a period of absence. Bad work habits (including bad posture and incorrect lifting techniques) can also lead to strains (see Advice for customers). Follow the RICED regimen above. If the area strained is not allowed to heal completely, it can remain painful and weak. TREATMENT OPTIONS Category Examples Comments Topical antiinflammatory agent Topical non-steroidal anti-inflammatory agents (NSAIDs) Oral non-steroidal anti-inflammatory agents (NSAIDs) Simple analgesics Sports taping and mouthguards Sports supports Natural / herbal products / supplements [GENERAL SALE] eg, mucopolysaccharide polysulfate (eg, Hirudoid) [GENERAL SALE] eg, ibuprofen (Nurofen Gel), diclofenac (Voltaren Emulgel*) [PHARMACY ONLY MEDICINE] eg, etofenamate (Rheumon Gel) [GENERAL SALE] eg, ibuprofen up to 25s (Advil, Nurofen) [PHARMACY ONLY MEDICINE] eg, diclofenac 12.5mg (Voltaren Rapid 12.5), ibuprofen >25s (Advil, Nurofen), ibuprofen + paracetamol (Maxigesic, Nuromol) [PHARMACIST ONLY MEDICINE] eg, diclofenac 25mg (Voltaren Rapid 25) [GENERAL SALE] eg, paracetamol (Panadol, Paracare) eg, Elastoplast sport, Kinesio Tex Tape, Leuko tape, USL sports tape and mouthguards eg, elastic supports, neoprene supports (Elastastrap, Thermastrap Supports) eg, arnica, comfrey, menthol eg, Anti-Flamme Creme, Anti-Flamme Extra, Tiger balm, Zorub Use for contusions, sprains, haematomas, bruises and swelling. These treat the body’s inflammatory reaction to injury and reduce pain, but evidence suggests they may delay tissue healing if used for longer than three days after the injury. Consult a doctor for advice. May, rarely, cause the same adverse effects as oral NSAIDs. Similar care and consideration before use is recommended. Avoid massaging for the first 48 hours after injury – rub in gently. These treat the body’s inflammatory reaction to injury and reduce pain, but evidence suggests they may delay tissue healing if used for longer than three days after the injury. Consult a doctor for advice. Ibuprofen is the NSAID least likely to cause stomach irritation. NSAIDs may not be suitable for people on certain other medications or with some medical conditions (eg, asthma, kidney disease – see Refer to pharmacist). Advise customer to stop taking if stomach upsets, increased bruising or prolonged bleeding occur see Reference Section, OTC Medicine Interactions, Precautions. Aspirin is not recommended for adolescents or children under 12 years old (see Childhood Pain and Baby Teething: Treatment options). May be beneficial as a first-line treatment for sprains and strains. Effective at relieving pain. Suitable for people with contraindications to NSAIDs. Strapping tape helps stabilise joints during exercise and should be removed immediately after exercise. Kinesio tapes have specific stretch, recoil and adhesive properties and can be worn for three to five days. Mouthguards should always be worn during contact sport. Elastic supports provide compression and support for wrists, ankles, knees and elbows. Comfrey and arnica have some pain-relieving properties. Menthol has a cooling effect. Heat rubs and other topical applications can also relieve pain and swelling (see also Muscular Aches and Pains: Treatment options). Products with an asterisk have a detailed listing in the Strains and Sprains section of OTC Products, on page 264. FIGHT AT A ROOT CAUSE* Voltaren ® Rapid 25 (diclofenac potassium 25 mg/tablet). Pharmacist Only Medicine. Indications and dosage: Adults and children 14 years: Temporary relief of acute pain where inflammation is present, such as sprains and strains, back and joint pains, migraine headaches and period pain. Initially 50 mg, then 20–50 mg every 8 hours if necessary (max 150 mg per day). Contraindications: Hypersensitivity to any ingredient; in asthma attacks, urticaria or rhinitis precipitated by aspirin or other NSAIDs; patients with previous myocardial infarction within the last 6–12 months; severe cardiac failure; hepatic failure; renal failure; active gastric or intestinal ulcer, bleeding or perforation; last trimester of pregnancy; children under 14 years. Interactions: Lithium/digoxin, other NSAIDs, corticosteroids, anticoagulants and antiplatelet agents, methotrexate, cyclosporin, glucocorticoids, voriconazole, phenytoin, diuretics and antihypertensive agents, drugs known to cause hyperkalaemia, oral antidiabetic agents, quinolone antibacterials. Adverse reactions (common): headache, dizziness, vertigo, nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, flatulence, decreased appetite, transaminases increased, rash. For less common adverse reactions see full Data Sheet. Voltaren is a registered trade mark of the GSK group of companies or its licensor. GSK Auckland, NZ. TAPS NA 9036. CHANZ/CHVOLT/0090/17. Voltaren Rapid 25 390x45.indd 1 Page 142 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION RICED regimen •• Rest – No further exercise for at least 48 hours. •• Ice – Apply ice (bags of frozen peas are ideal) for 20 minutes every two hours for the first 48 hours. Wrap ice in a moist towel to protect the skin from ice burn. •• Compression – Apply a crepe bandage that extends above and below the area to help limit bleeding and swelling. •• Elevation – Ideally raise the injury above the heart to help fluid drain away from the injury and limit swelling. •• Diagnosis – Consult a medical professional or sports physiotherapist for a precise diagnosis, ongoing care and treatment. A full recovery is then more likely. Initial assessment If a customer presents with an acute injury, apply ice to the affected area then run through the Refer to Pharmacist questions and refer any "yes" answers to a pharmacist. Any injury accompanied by severe pain, significant swelling or bruising, or restricted movement may indicate tendon or ligament damage and needs to be investigated by a doctor or physiotherapist. Strains may be treated with oral or topical analgesics. Offer advice about warming up before and after exercise in addition to stretching and strengthening exercises once the pain has gone. Advice for customers • Sprains, strains and other soft tissue injuries are best treated by the RICED regimen for the first 48 hours. »» Controlled mobilisation of the joint usually begins after 48 hours. »» Avoid HARMful activities (Heat, Alcohol, Running, Massage) for 48–72 hours after a sprain or strain. »» Allow enough time for the injury to heal properly. If surgery is needed, it may take at least six months before a person can return to sport. • Supports such as shoes with good ankle support, tape for ankle strapping, knee braces, etc, are important once activity is resumed. • With more severe injuries, non-weight-bearing exercise may be preferred initially (eg, swimming, cycling). • Organise work areas to make them more comfortable and avoid awkward working postures. • Practise correct lifting techniques and use two-person lifts. • Warm up, stretch and take regular breaks from intensive activities. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have health conditions (eg, diabetes, is pregnant or breast feeding), or is taking other medication, and is wanting oral or topical pain relief? • Has the pain persisted for five to seven days after the injury or got worse? • Is the pain or swelling very severe? • Is there a loss of normal range of movement or is there any numbness? • Is the pain affecting a person’s ability to function (eg, feeling dizzy)? • Is the strain or sprain in a child? • Does the injured area look crooked or have lumps and bumps (other than swelling) that are not seen on the uninjured joint? • Is the person unable to move the injured joint or walk more than four steps without significant pain? • Is there any redness or red streaks spreading out from the injury? • Has the area been injured several times before? • Is there pain, swelling, or redness over a bony part of the foot? • Does the person have any allergies to medicines? *TREAT THE INFLAMMATION PROVEN BACK PAIN RELIEF 10/04/17 5:16 pm Page 143

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