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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.

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

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

Click here to self-refer to a physiotherapist.

How to manage a sprain or a strain

DAY 1 – Early Management

Protect by minimising use of the affected arm and initially avoiding stretching the area which could cause further injury.

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.

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 shoulder can be achieved by using a 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. This is difficult for the shoulder. If you have swelling in your arm sit on a chair and place your arm on cushions so it is supported.

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 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. 

1. Pendular exercise

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

2.

In sitting or standing, roll your shoulders backwards and forwards.

3.

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.

4.

Sit or stand. Place your hands on a table. Slide your hands along the table as far as you can without lifting your shoulders. 

5.

Stand facing a wall. ‘Walk’ your fingers up the wall as high as possible. Reverse down in the same way. 

WEEK 2 – Strengthening Exercises

1.

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. 

2.

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.

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.    

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