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Assessing and treating injury If you ski enough, sooner or later you're going to fall. The question is, do you keep schussing away like a trooper, swollen knee be damned, or beeline it to the emergency room? Here's how to assess and treat your hard-earned injury. By Colleen A. Brennan, M.S.
Evaluating Your Condition Before you do anything else, evaluate your condition. Go slowly, even before you get to your feet. Quick movements can create more injury by causing microtears or by damaging already strained structures. In deciding whether to seek medical attention, assess four areas: pain, swelling, sensation, and movement. Pain. Pain serves an important function by warning you that something is not right in your body. Pay attention to it. In an acute injury, it can signal muscle tears, strains, ligament sprains, fractures, or nerve involvement. If your pain feels sharp, stabbing, burning, or severe, go to the emergency room. I often ask patients to rate their pain on a scale of zero to 10. Zero means no pain; 10 means the worst pain you could imagine. Pain above a five should be evaluated by a physician. Also, sharp pain that is persistent for several hours, radiates to other areas of your body, or prevents you from sleeping warrants medical attention. Soreness is a different kind of pain. Generally, it is a dull throbbing or aching that lasts two to 24 hours. Soreness alone typically doesn't prevent further activity, and there is no need to see a doctor. Swelling. Swelling, or edema, is one of the first steps the body takes on the road to repair. Inflammation occurs as fluid shifts and leaks from within damaged cells. This creates pressure on tissues, causing pain. Massive swelling may indicate fracture or rupture. If you hear popping or tearing sounds that are accompanied by edema, seek medical attention. Sensation. Numbness or tingling typically indicates nerve involvement in an injury. Such sensations signal damage that may require treatment and should be evaluated by a physician. Movement. Ask yourself if you can move the affected area smoothly. Can you move in full range? Can you tolerate the pressure of your full body weight? If you are unable to perform these tasks, you may need medical attention. Often, if you are unable to walk without a limp, crutches are in order; such assistance can enforce rest and promote healing. The PRICE Is Right If your initial evaluation leads you to believe you don't need medical attention, there's still plenty you can -- and should -- do to treat yourself. You've probably heard of the acronym RICE when it comes to treating acute injuries; it stands for rest, ice, compression, and elevation. While all that still works, current thinking adds another element to the list: painkillers. The acronym to remember now is PRICE. The goal of this treatment is to reduce swelling as quickly as possible, so for best results, be sure to start as soon as possible. Pain relievers. You can take ibuprofen or acetaminophen to make you more comfortable and tolerant of movement. Use it consistently for the first 72 hours. Don't wait for the pain to get severe before you start. Rest. Rest is crucial to quick recovery. Damaged tissues need time to heal, so resist the urge to get back on the slopes -- or to take part in any other activity that engages your injured parts -- until the swelling and pain have decreased significantly. Returning too quickly puts you at risk for reinjury -- and often more severe injury -- which can be the start of a chronic problem. If you're desperate for activity, try a non-weight-bearing activity like swimming. In addition, during this rest phase, be sure to eat well and stay hydrated, which are vital to the healing process. Ice. Ice speeds healing in a number of ways. Primarily, it decreases blood flow to the affected area -- the technical term for this action is vasoconstriction -- which in turn reduces swelling. The cold also decreases metabolism and enzyme activity locally, which can prevent further tissue damage, thus speeding healing. Ice also produces local analgesia -- a fancy way of saying you'll hurt less. When in doubt, ice! A common mistake is to use heat after an injury. Although it may feel pleasant initially, the end result is increased swelling, increased pain, and slower healing. Anytime swelling is present, use ice. This applies regardless of when the injury occurred. Heat is indicated only for muscle soreness, fatigue, or stiffness. Apply ice for 20 minutes at a time, several times a day. Icing for longer than that is counterproductive, since as the temperature of the skin and the ice equalize, the vasoconstriction effect disappears. Longer application also puts you at risk for frostbite or burns to the skin. Compression. Compression decreases swelling and provides support for injured structures. It is essential to apply compression evenly to avoid shifting fluid to other areas or blocking the blood supply. Apply commercial bandage wraps in a diagonal, crisscross pattern; horizontal wrapping can cut off the blood flow as a tourniquet would. Or try a neoprene sleeve, designed to provide smooth, even support for specific body parts. Sporting goods stores and pharmacies typically sell these devices. Elevation. While you are resting, the injured area should be elevated on pillows to keep it higher than your heart. This allows gravity to return excess fluid to the heart, reducing edema and, in turn, reducing pain. Also, minimize the time you spend standing. When you're upright, gravity pulls more fluid to the injury and delays healing. Keep this in mind when you return to work. Try to put your feet up every few hours if you've been standing, or keep your legs propped up on a chair while you're at your desk. After the Fall Practice these healing techniques as long as you have pain, swelling, or limitations in movement. After the first three days, you may be ready to increase activity, begin gentle stretching, or even return to training. In the meantime, consider visiting a physical therapist, who can help evaluate your injury, treat the symptoms, reduce pain and edema, and return you to activity as fast as possible. Treatment typically includes a combination of inflammation-reducing techniques, education, stretching, strengthening, and conditioning. Then it's up to you to keep from falling off the chairlift again! Colleen A. Brennan has a B.A. in Human Biology from Stanford University and an M.S. in physical therapy from Duke University. She has been practicing physical therapy at Stanford Hospital for eight years.
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