Acute Sprains and Strains: Management
Managing muscular sprains and strains
Fortunately, sprains and strains typically respond well to treatment.
Patients with sprains and/or strains should start to feel better after 2 weeks without any intervention.1
Below we review the different approaches that could help your patient get back to enjoying their life in the case of acute, mild-moderate sprain/strain injuries.
American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) clinical guideline recommendation for treating acute sprains and strains
The ACP and AAFP recommend Topical NSAIDs as 1st line and oral NSAIDs or acetaminophen as 2nd line treatments for acute, non-low back MSK pain2
The American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) developed this guideline to provide clinical recommendations on nonpharmacologic and pharmacologic management of acute pain from non–low back, musculoskeletal injuries in adults in the outpatient setting based on a systematic evidence review on the comparative efficacy and safety. The guidance is based on current best available evidence about benefits and harms, taken in the context of costs and patient values and preferences.2
- Recommendation 1:ACP and AAFP recommend that clinicians treat patients with acute pain from non–low back, musculoskeletal injuries with topical nonsteroidal anti-inflammatory drugs (NSAIDs) with or without menthol gel as first-line therapy to reduce or relieve symptoms, including pain and improve the patient's treatment satisfaction2
- Recommendation 2: ACP and AAFP suggest that clinicians treat patients with acute pain from non–low back, musculoskeletal injuries with oral NSAIDs to reduce or relieve symptoms, including pain, or with oral acetaminophen to reduce pain.2
NICE guideline recommendation for treating sprains and strains
Sprains and strains can be managed simply in the first 48- 72 hours following the soft tissue injury3
According to guidance from the National Institute for Health and Care Excellence, patients with sprains or strains should be advised to follow the PRICE protocol in the first few days after the injury.3-5
The HARM protocol identifies key factors that should be avoided for the first 72 hours post-acute injury.6
Read more about these approaches below.
PRICE protocol for sprains and strains
PRICE stands for:3-5
- Protect from further injury (e.g., by using joint supports)3,5
* Important: If Voltaren is recommended, it should NOT be used with occlusive dressings.7,8
- For the first 48–72 hours after injury3,5
- Apply ice wrapped in a damp towel for 15–20 minutes every 2–3 hours during the day (while awake) for the first 48–72 hours after injury3,5
- With a snug (not tight) elastic or tubular bandage, while the patient is awake3,5
* Important: Voltaren should NOT be used with occlusive dressings, as absorption of diclofenac through the skin can be increased by 3–10 times after application of an occlusive dressing.7,8
- Keep the injured area raised and supported on a pillow until the swelling is reduced3,5
The PRICE protocol summarizes how patients can take care of their acute sprain or strain in the first few days after the injury.3
The HARM protocol for sprains and strains
HARM describes some key factors to avoid in the first 72 hours after an injury:6
- Avoid heat sources such as baths and heat packs. Heat encourages blood flow, which will tend to increase bruising and inflammation6
- Avoid alcohol, which can increase bleeding and swelling and reduce healing6
- Avoid running or other forms of exercise that can cause further damage6
- Avoid massage, which can increase bleeding and swelling6
The HARM protocol summarizes what patients should avoid in the first 72 hours if they have a sprain or strain.6
Analgesics can be used to relieve pain from acute sprains and strains
Acetaminophen, topical non-steroidal anti-inflammatory drug (NSAID) medications, or oral NSAIDs can be used to help manage acute sprains and strains.4*
* These products should not be used together.
Utilizing physical therapy to improve outcomes
After the first 72 hours, physiotherapeutic interventions can be beneficial for soft tissue injuries
Treatment and rehabilitation plans must be individually tailored to maintain and improve range of motion, reduce pain and inflammation, and improve functional activities.9
For example, massage therapy can reduce muscle soreness — although this should not be used in the first 72 hours after the injury.6
Appropriate strengthening programs using tailored exercises are often required in the longer term to maximize recovery, and training regimens may need to be adjusted.9
How can Terry & Nicola be helped?
Terry* has sprained his ankle from playing tennis and is struggling to work and take care of his children.
Terry wants effective pain relief.
Voltaren is absorbed through the skin to reach the area of inflammation, providing relief from pain and inflammation after soft tissue injuries, so Terry can get back to doing the activities he enjoys.10
* Fictional case study.
Nicola* has strained her back after a weekend gardening and is having trouble performing everyday activities.
Nicola wants pain relief.
Advil Liqui-Gels act fast to relieve acute pain from backache so that Nicola can get back to her busy lifestyle and gardening on the weekends.11,12
* Fictional case study.