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Early management of sprains and strains

 

Minor injuries to the hip, such as a mild sprain or strain should settle with time and can be managed at home.

A soft tissue injury to the hip may result in the following:

  • Pain
  • Swelling
  • Bruising
  • Stiffness and loss of function

The pain can be particularly strong in the first three weeks as this is the inflammatory phase of your body healing itself. Typically, these injuries last 4 to 6 weeks depending on the severity.

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Go to an urgent treatment centre or emergency department if you:

  • have severe pain or feel faint, dizzy or sick from the pain
  • heard a snap, grinding or popping noise at the time of the injury,
  • you are unable to weight bear because of the pain

These might be signs of a more severe injury which may need medical attention.

See a GP or physiotherapist if:

  • the pain is severe or stopping you doing normal activities
  • the pain is getting worse and/or keeps coming back
  • the pain has not improved in any capacity after treating it at home for 2 weeks

How to manage a sprain or a strain

DAY 1 – Early Management

Protect by minimising use of the affected area and initially avoiding stretching the area which could cause further injury. You may require the use of a walking aid to offload pressure on the affected side. You may find it easier to go upstairs leading with good leg first, and downstairs with the affected leg first.

Rest can be beneficial in the very early stages of the injury (days 1-4). Complete rest, however, is not advisable. In the early stages, gentle active movements and specific exercises can help decrease pain and swelling, they also promote good tissue healing with less unwanted scar tissue and joint stiffness. It is important to make sure you keep your knee and ankle moving as able, so they do not stiffen up.

Ice pack/frozen peas wrapped in a damp cloth, placed on the swollen area for up to 20 minutes at a time, 3 times a day. So long as there is swelling you will need to continue ice therapy, often beyond the third week.

  • Please note only use ice if you have normal skin sensation
  • Check the skin regularly
  • Stop if there is excessive pain, numbness or tingling
  • Do not put ice directly on to the skin as this may cause a burn.

Compression of the hip is very difficult to achieve but you can use tubigrip or crepe bandage. It should compress firmly but not restrict blood flow and create a tourniquet.  Remove if there are signs of poor circulation, or if you start to experience pins and needles or numbness.

Elevation. If you have swelling in your knee, try to keep it level or slightly higher than your hip. You can help achieve this with use of pillows.

Click here for a video of how to manage a sprain or strain at home.

WEEK 1 – Early Mobilisation

After 72 hours is important to start using your hip as your pain allows. Start to do normal everyday activities. You should also try doing these exercises 3 – 4 times a day. Repeat each one 10 times.

Knee exercises

1. Lying on your back, bend your knee up towards you, sliding your foot and then let it return.
2. Sitting on a chair bend your knee back as far as it can comfortably go.

 

3. Sitting on a chair, slowly straighten your knee as high as it can go and slowly lower it down again.

 

Hip exercises

1. Lying on your back, lift your knee towards you and then let it come back down.
2. Lying on your back, slide your whole leg out to the side in an arc and return.

WEEK 2 – Strengthening Exercises

You can start these when pain is starting to settle.

Knee exercises

1. Lying on your back, squeeze your knee in to the bed.  Hold up to 5 seconds and relax.
2. Lying on your back, lift your leg up straight approximately 30 cm off the floor / bed.  Hold up to 10 seconds and slowly lower it down.
3. Sitting in a chair.  Stand up and sit down slowly.  Try not to use your hands if possible.  Make this harder by:

a) moving the foot of your affected knee closer to you and then progress to

b) standing from a lower height.

4. In standing with feet apart, hold on to something in front to steady yourself. Keeping your back upright, slowly let your knees bend and return to upright. To begin with you may not do much of a dip and that is ok, the important thing is to be in control. Gradually progress to a deeper dip or a 5 second hold at the deepest part.

Hip exercises

1. Standing up and holding on to something if you need to.  Take your leg out to the side and return.
2. Standing up and holding on to something if you need to.  Take your leg behind you and return. Remember to keep your back up right and don’t lean forward.
3. Standing up and holding on to something if you need to. Lift your knee towards your chest and then lower it down.
As you start to do these exercises you may feel there is some discomfort, however, this is okay and you should continue. If you have discomfort and pain for more than 2 hours after these exercises, then you should reduce the number and gradually build up again.

Recovery time and returning to activity 

It usually takes 6 weeks to heal from simple soft tissue injuries to the hip or knee.  However, everyone recovers from injuries at different rates. Some may be back in a few days however for some it can take a number of months.

Returning to work – Gradually build up your strength and function, practice doing similar tasks that you would do at work before returning. Start doing this little and often ensuring there is minimal pain or swelling.

Returning to hobbies/sport – it is advised not to return to these activities until you have full strength and range of movement without pain or swelling. Try to practice the specific movements of your hobby / sport in a controlled manner and build up the time and intensity that you do the movements before returning to your activity fully.

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