Non-Operative treatment for sports injuries and orthopaedic conditions may involve a combination of things such as relative rest, ice, oral medications (pain killers and anti-inflammatory medication), supplements, braces, splints, walking aids, injections and physiotherapy.
ICE or "P.R.I.C.E."
Braces, Splints and Walking Aids
If you have a sports injury the first thing to do is to prevent further injury or damage. This means you should stop activity and look for the cause of the injury. Once you determine what is wrong, you can start immediate treatment.
The first treatment for most acute soft tissue injuries (bruises, strains, tears) is to minimise further swelling. When soft tissue is damaged it swells or possibly bleeds internally. This swelling causes pain and loss of motion, which limits use of the muscles.
The primary treatment for soft tissue injuries is "P.R.I.C.E."
- Protection, Rest (and Rehabilitation), Ice (and Immobilisation), Compression and Elevation.
The PRICE protocol should be applied immediately after an injury occurs, before being treated by Emergency Professionals.
P is for Protection - Protect any injury from further damage. Stop playing, use padding or protective dressings if required. Splints and crutches should be used to take the weight off a knee, ankle or other lower limb injury. Slings or splints may be used for upper-limb injuries. A simple stick or rolled up magazine or newspaper can splint a fractured arm, forearm or wrist. "Buddy-strapping" a finger injury to an adjacent uninjured finger is a helpful technique.
R is for Rest and Rehabilitation - Rest means to stop activity and give the tissues time to heal. Being brave and playing on is not always wise. Ensure Rehabilitation time to allow even a small injury to heal.
I is for Ice - By applying Ice either from a freezer, a commercial gel ice pack or even a pack of frozen peas onto the injury you will reduce the pain and inflammation. Very cold products can induce hypothermia or cold burn to the skin so wrapping the ice in a cloth is advisable. A moist cloth will allow more effective transfer of cold to the injured area. Remember to keep icing time to short bursts of 10 -15 mins. Wait for the area to become warm again before re-applying ice.
C is for Compression - Compression of an acute injury is perhaps the next most important immediate treatment tip. By quickly wrapping the injured body part with an elastic bandage or wrap you help keep swelling to a minimum. Cohesive, Tear Tape, crepe or any stretchy bandage will suffice. Do not get these bandages mixed up with EAB (Elastic Cohesive Bandage) which is a product for support and compression that needs training to use.
E is for Elevation � Elevating the injury to above the heart prevents the flow of blood to the area and reduces the swelling.
Never apply heat to an acute injury. Heat will increase circulation and increases swelling. Avoid H.A.R.M. or Heat, Alcohol, Running (or any exercise) and Massage for at least 72 hours post injury.
Immediate Treatment Tips
Here is what you should do immediately when you sustain a sports injury:
- Stop the activity immediately.
- Wrap the injured part in a compression bandage.
- Apply ice to the injured part BUT NOT DIRECTLY TO THE SKIN as this actually can cause hypothermic injury to the skin (use a bag of crushed ice, a bag of frozen vegetables or cold gel pack) for 10-15 minutes. Let the area warm completely before applying ice again (to prevent frostbite).
- Elevate the injured part to reduce swelling.
- Get to a sports doctor for a proper diagnosis of any serious injury.
After a day or two of P.R.I.C.E., many sprains, strains or other injuries will begin to heal. But if your pain or swelling does not decrease after 48 hours, make an appointment to see your doctor or go to the emergency room, depending upon the severity of your symptoms.
Once the healing process has begun, very light massage may improve the function of forming scar tissue, reduce healing time and decrease the possibility of injury recurrence.
Gentle stretching can be begun once all swelling has subsided. Try to work the entire range of motion of the injured joint or muscle, but be extremely careful not to force a stretch, or you risk re-injury to the area. Keep in mind that a stretch should never cause pain.
Heat may be helpful once the injury moves out of the acute phase and swelling and bleeding has stopped (usually after 72 hours). Moist heat will increase blood supply to the damaged area and promote healing.
Finally, after the injury has healed, strengthening exercises can be begun.
Simple analgesia such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen (Nurofen) or Celecoxib (Celebrex) are often helpful in the management of pain in many sporting injuries and arthritic conditions. "Multi-modal" analgesia involves using various types of painkillers that have differing mechanisms of action on the pain pathways. By using this method of combining several simple analgesics such as Paracetamol and NSAIDs, stronger painkillers such as narcotics may not be necessary. However, if required, prescription medication including narcotics like codeine and oxycodone may be prescribed.
NSAIDs are also helpful in the management of inflammation in the setting of acute sporting injuries, bursitis, subacromial impingement of the shoulder and joint inflammation related to arthritis of most joints.
It is important to remember that NSAIDs are associated with several side effects. The frequency of side effects varies among NSAIDs. The most common side effects are nausea, vomiting, diarrhoea, constipation, decreased appetite, rash, dizziness, headache, and drowsiness. NSAIDs may also cause fluid retention, leading to oedema. The most serious side effects are kidney failure, liver failure, ulcers and prolonged bleeding after an injury or surgery.
Some individuals are allergic to NSAIDs and may develop shortness of breath when an NSAID is taken. People with asthma are at a higher risk for experiencing serious allergic reaction to NSAIDs. Individuals with a serious allergy to one NSAID are likely to experience a similar reaction to a different NSAID.
Use of aspirin in children and teenagers with chickenpox or influenza has been associated with the development of Reye's syndrome. Therefore, aspirin and non-aspirin salicylates should not be used in children and teenagers with suspected or confirmed chickenpox or influenza.
NSAIDs may increase the risk of potentially fatal, stomach and intestinal adverse reactions (for example, bleeding, ulcers, and perforation of the stomach or intestines). These events can occur at any time during treatment and without warning symptoms. Elderly patients are at greater risk for these adverse events. NSAIDs (except low dose aspirin) may increase the risk of potentially fatal heart attacks, stroke, and related conditions. This risk may increase with duration of use and in patients who have underlying risk factors for heart and blood vessel disease. NSAIDs should not be used for the treatment of pain resulting from coronary artery bypass graft (CABG) surgery.
Glucosamine and Chondroitin have been shown in clinical trials to be as effective as certain non-steroidal anti-inflammatory medications in the management of arthritic pain. The "GAIT" Glucosamine/Chondroitin Arthritis Intervention Trial (13 Universities - United States Study) showed that "Combination of glucosamine and chondroitin sulfate is effective in treating moderate to severe knee pain due to osteoarthritis."
Glucosamine and Chondroitin also may help slow the progression of cartilage wear and can be used long term with little or no side effects in contrast to non-steroidal anti-inflammatory medication.
Several supplements are available to help manage arthritis. These include:
- Glucosamine Sulfate / HCL
- Chondroitin Sulfate
- Omega 3 Fatty Acids (Fish Oil and Flaxseed Oil)
- Manganese Ascorbate
- Boswellia Serrata (Boswellin)
- Vitamin C
- Vitamin A
- Vitamin E
- Aloe Vera
Braces, Splints and Walking Aids
NQO has various braces and splints available onsite for the treatment of sporting injuries and for post-operative care. Braces not available onsite can be ordered through our supplier Donjoy.
The braces available include:
- Knee Ligament Bracing
- Post-Op Bracing for Shoulder, Elbow and Knee Surgery
- Osteoarthritis Bracing
- Patellofemoral Bracing
- General Knee & Thigh Supports
- Walking Braces
- Ankle Braces
- Upper Extremity Bracing
- Wrist & Elbow Braces
Walking aids such as crutches, sticks, wheelie walkers and pick-up frames can be ordered if necessary and instruction on their use provided by the physiotherapists.
Physiotherapy is extensively utilized at Townsville Orthopaedics for the treatment of orthopaedic conditions, sporting injuries and post-operative rehabilitation.
Patients can be helped with physio using a range of different techniques including:
- Postural advice, biomechanical assessment and therapeutic exercise prescription
- Stretches, strengthening and plyometric exercises
- Biofeedback training, proprioceptive and balance exercises
- Soft tissue techniques such as massage, trigger point de-activation and soft tissue releases
- Joint mobilisation and manipulation
- Therapeutic taping for pain relief and injury prevention
- Pilates exercises including core stability exercises or 'body control'
- Swiss ball exercises
- Graduated and progressive return to sport
- Sport-specific rehabilitation and running analysis
- Post-operative rehabilitation
- Semi rigid orthotic prescription
- Sports strapping and bracing
- Walking aid and post-operative brace fitting
- Electrophysical modalities (electrotherapy ) for acute inflammation such as intermittent compression, ultrasound and ice.
The physios involved with NQO have expertise in assessment, treatment and return of athletes to sport, from elite to recreational level. At NQO the physiotherapists are involved in the care of local sporting teams bringing this knowledge and expertise to the practice.
NQO physios are experienced in providing rehabilitation to regain normal function after injury or orthopaedic surgery. Strengthening and stretching exercises are supervised in the clinic and prescribed in home programmes.
When the above treatments fail to provide an adequate response, injections into the joints or soft tissues in the form of local anaesthetic and corticosteroid can be used.
Corticosteroids such as Celestone (Betamethasone) have a complex mechanism of action. They bind to glucocorticoid receptors and regulate gene transcription which leads to a vascular stabilising effect. Capillary dilation and vascular permeability is reduced. By altering protein synthesis corticosteroids reduce the production of cytokines and other inflammatory mediators. The end effect is a reduction in inflammation, swelling and pain.
The corticosteroid injections can be used in a number of conditions including subacromial impingement, rotator cuff tears, tennis elbow, arthritis (shoulder, wrist, elbow, knee and hip) and tendonitis.
Synvisc (hylan G-F 20) is an elastic and viscous fluid that is made from a substance called hyaluronan that is found in normal joint fluid. Hyaluronan acts as a "shock absorber" and lubricant in the knee joint and is needed for the knee joint to work properly. Hyaluronan and hylan (HA) products provide another alternative treatment option for OA in individual knee joints.
To evaluate the efficacy, effectiveness and safety of HA products, in knee OA The Cochrane Collaboration conducted a systematic review using Cochrane methodology (The Cochrane Library contains high-quality, independent evidence to inform healthcare decision-making. It includes reliable evidence from Cochrane and other systematic reviews, clinical trials, and more. Cochrane reviews bring you the combined results of the world's best medical research studies, and are recognised as the gold standard in evidence-based health care).
The analyses from The Cochrane Collaboration supported the contention that the HA class of products is superior to placebo. The analyses suggested that viscosupplements are comparable in efficacy to systemic forms of active intervention, with more local reactions but fewer systemic adverse events, and that HA products have more prolonged effects than IA corticosteroids. Overall, the aforementioned analyses support the use of the HA class of products in the treatment of knee OA.