FIRST AID FOR SOFT TISSUE INJURIES

This advice is aimed towards anyone that has sustained a soft tissue injury.

Following a soft tissue injury it is essential that damage is minimised by applying the correct immediate first aid to the affected area or limb. Injuries such as strains or sprains produce varying levels of trauma based on the severity of the injury. The result is a corresponding level of haemorrhaging at the injury site that can lead to compression of the surrounding tissue and may lead to greater damage.

There may be no obvious indication of an injury other than discomfort but if there has been a significant event, then bruising, swelling and possibly even deformity may accompany any pain. If you suspect that you have sustained a more serious injury then you should seek medical assistance. Many people apply deep heat to an injury or have a hot bath which actually has a negative effect and will in most cases worsen the condition as it encourages further swelling.

It is essential for the rehabilitation process to begin as soon as possible following the incident to limit the extent of damage and prevent the condition worsening and prolonging inactivity which could potentially lead to a chronic injury. The procedure that initiates injury rehabilitation occurs in two stages and can be remembered by the pneumonic of RICE and MICE.

RICE is the initial procedure that should be carried out and needs to be maintained for the first 24 - 48 hours after sustaining an injury depending on its severity.

• R - Rest. The injured area should be rested as continuing activity with it could cause further damage increasing bleeding and swelling which will prevent clotting and slow down the healing process. In the case of sprains, damaged ligaments should be kept in a shortened condition to reduce the tension and allow the fibres to begin knitting together.
• I - Ice (cryotherapy). Ice should be applied periodically to the injury site for about 10 minutes, reapplying it 15 minutes later during the initial 1-2 hours following an injury. This causes constriction of the blood vessels in the damaged tissue which reduces the bleeding and therefore inflammation and swelling and also offers an analgesic effect providing a degree of pain relief. Care must be taken when applying ice as freezing can occur causing tissue damage with prolonged use. Ice packs or should always be wrapped in a damp cloth to prevent direct contact with the skin.

• C - Compression. Broad strapping over the site of the injury is the most effective method of compression which places pressure on damaged blood vessels reducing bleeding and preventing swelling. If you experience pins and needles in the extremities of the area that is being compressed or if you notice that the skin is turning a whitish grey, the compression is too tight and you must re-apply the strapping with less pressure.
• E - Elevation. Raising a damaged limb, ideally above the level of the heart, assists gravity to reduce the blood pressure in the damaged tissue to minimise bleeding and interstitial fluid seeping into surrounding tissue causing swelling.

Following the RICE regimen, which usually lasts about 48 hours, the Post-Acute phase (MICE) should begin and consists of:

• M - Mobilisation. Early mobilisation (movement) of an injury has many benefits and helps to maintain the strength of muscles and prevent a reduction in their size (atrophy). Activity should be progressive in nature which encourages joint nourishment preventing stiffness and helps the repair of damaged tissue.
  Mobilisation initially should be carried out without bearing weight or working against resistance and can be active where the person with the injury creates movement themself or passive where a therapist controls movement. The injury should be moved in all directions to the point where mild resistance is met and as this phase continues exercises can be introduced where the joint is fixed and the muscle contracted gently.
  If it is a joint that has been injured, protected mobilisation using taping, strapping or braces can prevent excessive movement in a particular direction and provide psychological security. As mobilisation continues, the range of movement of the joint or muscle increases and the fibres damaged during the injury are realigned. This helps to remove fibrous adhesions that have occurred regenerating muscle fibre as a net result.
  If pain is experienced at any stage, exercise should stop and only be continued if it disappears after 20 - 30secs. If it doesn't, the treatment for the acute stage (RICE) should be re-commenced.
• I - Ice (cryotherapy). Should be continued for about a week and then contrast therapy where alternate hot and cold bathing can commence. The heat from a warm source dilates blood vessels and increases circulation to the injury feeding it with fresh blood containing nutrients to assist the healing process, but should only be applied if inflammation has ceased and for no more than 30 minutes. The cold therapy restricts bleeding if the vessels are still damaged.
• C - Compression. Compression should be removed gradually after a few days as swelling reduces.
• E - Elevation. Elevate as often as possible until swelling has ceased.