Niketa Wells - International Taekwon-do Federation of New Zealand

REGULAROPTIMAL EARLY TREATMENT OF COMMON SOFT TISSUE INJURIESBy Dr Jake Pearson IV dan, KhandallahSPORTS MEDICINELike it or not, injuries are an unavoidableconsequence of participation in anyphysically demanding activity. Hopefullythese are mild, however, and with goodtreatment the interruption to trainingrelatively brief. For our elite athletes, thedifference of a few days’ recovery canbe crucial, particularly around the timeof major competition, but even for thoseof us at the more recreational end ofthe spectrum it is useful to know how tomaximise speed and quality of recovery.I am talking here about joint sprains, musclestrains or significant contusion/bruising. Afew specific joint injuries have been coveredin previous articles, and some, for exampleACL injuries in the knee, require morespecialised treatment. However, for mostmild to moderate injuries the followingprinciples will apply. I see patients in myclinic every day who are suffering mediumorlong-term consequences at least in partdue to inappropriate initial treatment. It ispossible to be overprotective of an injuryand cause other problems or delayedrecovery; however, it is my hunch thatthe majority of TKDers may rather havea tendency to “tough it out” or brush offthese sorts of injuries, and their bodies maysuffer as a result.The treatment during the first 24 hoursfollowing an injury is the most important,and the age-old acronym of RICE (rest,ice, compression, elevation) remainsthe cornerstone of early management.It has been suggested that this shouldbe expanded to PRICE (addition of‘protection’ i.e. from further injury with abrace/splint for a period for some injuries)or even to PRICED (addition of ‘diagnosis’at the end, particularly if things do notsettle reasonably quickly, obviously fromsomeone suitably qualified rather thanDr Google). The primary aim of thesemeasures is to minimise the degree ofbleeding, which can cause further tissuedamage and inhibit healing.Rest is hopefully self-explanatory.Remember this applies to the injured bodypart only, and it is usually possible to stayactive in some way without stressing thedamaged area. Ice is best applied for 10-15 min. intervals every30-60 mins. Beware of“ice burns” from verycold substances helddirectly on the skin.Compression is usuallybest achieved with abandage, ideally withice treatment appliedsimultaneously. Firmpressure should beapplied but not sotight as to cause pain.Elevation: the injuredpart should ideallybe above the level ofthe shoulder (arm/hand injury) or pelvis(leg/foot injury) toencourage drainage ofextra fluid. In additionto P/RICE/D, youshould avoid HARM inthe early stages – Heat,Alcohol, Running/exercise, and Massage.Most of these are selfexplanatory,althoughavoiding massagemay surprise some;remember this applies to the first 24-48hours after injury and also to firm massagedirectly on the injured area as opposed tosurrounding areas.Whether or not to immobilise with a cast,splint or strapping depends a lot on thenature and severity of the specific injury;however, there often is a role for a fairlyhigh degree of protection in the first 24-48 hours for moderately severe injuries.The art then is to know how much toget moving and in what way, and the term‘protected mobilisation’ describes this. Theinput of an appropriately trained healthprofessional at this point is desirable.The role of anti-inflammatory medication(e.g. “Voltaren” or “Neurofen”) in theearly stages of soft tissue injury remainsa contentious topic. My advice is toavoid these if possible for the first 48hours (there is the possibility they couldincrease bleeding early on), and ratherto use regular Paracetamol (“Panadol”)for pain relief. There is evidence thattaking anti-inflammatories between days2-10 following an ankle sprain speeds uprecovery; however, whether there is anylonger-term effect on healing is uncertain.Completing an appropriate rehabilitationprogram under guidance of your healthprofessional is then the key to recoveringas quickly and completely as possible.In generally this will involve regainingmovement, then strength and finallyfunction in approximately that order,with some overlap. Rehabilitation usuallycontinues well after an athlete has returnedto their sport. Many people underestimatethe time and effort required for this, andthe quality of their recovery may reflectthis.Remember though that avoiding injury ispreferable to even the best treatment. Sogo hard but also “take care out there”.ISSUE TWO, 201243