2017 HCHB_digital

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