Early management of sprains and strains
Minor injuries to the shoulder such as a mild sprain or strain are very common and should settle with time. They can often be managed at home.
A soft tissue injury to the shoulder 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.
Up to date guidelines can be found on the NHS website:
Get advice from 111 now if:
- the pain is sudden or very bad
- you cannot move your arm
- your arm or shoulder has changed shape or is badly swollen
- you have pins and needles that do not go away
- there’s no feeling in your arm or shoulder
- your arm or shoulder is hot or cold to touch
These could be signs of something more serious.
You can also call 111 for advice or go 111.nhs.uk.
Speak to 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 following the simple advice below
How to manage a sprain or a strain
DAY 1 – Early Management
Protect: Rest or restrict movement for 1 to 3 days after injury to minimise bleeding and prevent further injury.
Elevate: Elevate the injured limb above heart level to reduce swelling.
Avoid anti-inflammatories: Avoid non-steroidal anti-inflammatory drugs (NSAIDs), like Ibuprofen and Naproxen, as the inflammatory process is necessary for tissue repair. Icing a new injury can hinder the natural healing process so avoid this if you can. You can use pain medication like paracetamol. Take this regularly to control the pain and always follow the instructions on the packet.
Compression: Use an elastic bandage or wrap to help reduce swelling.
Education: Best practice advice now focuses on an active recovery, encouraging movement, and there is a recommendation to avoid passive treatments where you remain still and treatment is done to you. An active approach has been shown to improve recovery in the short and long term.
After the first few days, follow the L.O.V.E guide below
Load: Gradually reintroduce movement and normal activities. Optimal loading without increasing pain promotes tissue repair, builds tissue tolerance, and improves strength.
Optimism: Maintain a positive outlook. Psychological factors like depression, fear and worry regarding damage to tissues or getting moving again can hinder recovery.
Vascularisation: Engage in pain-free cardiovascular activity to increase blood flow to the injured area and promote healing.
Exercise: Restore strength, mobility, balance and coordination by incorporating specific exercises into the rehabilitation plan as soon as you feel able.
WEEK 1 – Early Mobilisation
After 72 hours is important to start using your shoulder normally again. Start to do normally everyday activities. You should also try doing these exercises 3 – 4 times a day. Repeat each one 10 times.
Pendulum exercises
Stand leaning on a table supporting your body weight with the other hand. Let your affected arm hang, relaxed, straight down.
- Swing your arm forwards and backwards 30 seconds
- Swing your arm sideways, left and right
- Swing your arm in a circle
Shoulder Rolls
In sitting or standing, roll your shoulders backwards and forwards.
Shoulder raises – sideways assisted)
Lie on your back, on your bed, with your elbows bent. Hold one wrist with your other hand. Lift the affected arm, assisting with your other hand.
Table Slides
Sit or stand. Place your hands on a table. Slide your hands along the table as far as you can without lifting your shoulders.
Walking your hand up the wall
Stand facing a wall. ‘Walk’ your fingers up the wall as high as possible. Reverse down in the same way.
WEEK 2 – Strengthening Exercises
Strengthening Exercises
Isometric Exercises – external rotation
Stand or sit. Hold your upper arm close to your body with your elbow at a right angle. Try to move your hand outward, resisting the movement with the other hand. There should be no movement.
Hold for 10 seconds and repeat 3 times.
Isometric Exercises – internal rotation
Stand with your arm close to your side and your elbow at a right angle. Push the palm of your hand against the other hand. There should be no movement.
Hold for 10 secs and repeat 3 times.
As you start to do these exercises you may feel there is some discomfort, however, this is normal 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 shoulder. However, everyone recovers from injuries at different rates. Some may recover 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 or 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.