Injuries - Immediate Care
Serious pathologies are rare – however if these conditions are present, you should seek medical advice from your GP or Healthline – free on 0800 611 116:
Escalating pain or worsening symptoms not responding to self management or medication, fever or weight loss, night pain preventing sleep, unable to lie flat.
Visit the Emergency Department or phone 111 in the event of: chest pain or tightness lasting several minutes, especially combined with shortness of breath, nausea or fatigue. Difficulty breathing, severe burns or bleeding, or bleeding that won’t stop. Sudden weakness or difficulty talking, fainting or unconsciousness. Saddle area numbness, pins and needles in both arms or both legs, sudden loss of bladder or bowel function.
If in doubt - get it checked out!
If you are finding it difficult to weight or move a particular joint after a traumatic injury, go to the Emergency Department and have it checked out - fractures and soft tissue ruptures are best treated quickly - don’t just hope for the best.
We can help recovery at this point by ‘PRICE’:
Prevent further damage, early use of slings and splints can be useful. Avoid using heat or massage at this point as it will increase bloodflow and swelling to the area, the injury needs to settle and allow the production of scar tissue.
Initially avoid using the injured site. Gentle, pain free movements will reduce stiffening and encourage lymphatic drainage.
Apply an ice pack or bag of frozen peas, wrapped in a wet tea towel for 10 to 15 minutes. For hands and feet, try a tub of cold water with ice cubes in it. Repeat every few hours while still swollen.
Apply a stretch-bandage to control swelling and add support. Not too tight – check for numbness and loss of colour, loosen at night.
Above heart level to reduce swelling and encourage lymphatic drainage. If it’s comfortable try a little gentle movement – this ball rolling method is superb to drain swollen ankles and knees – works really well post op too…
Avoid using heat or massage at this point as it will increase bloodflow and swelling to the area, the injury needs to settle and allow the production of scar tissue.
Further treatment depends on how severe your injury is…
Less severe injuries should see pain and swelling settling within two to three days, allowing further pain-free movement, returning to full range, strength and normal use over the next few weeks. In this phase I like the approach of ‘3/10 for effort’ – short little bursts of light movement which is not too painful. Doing this little and often reassures our nervous system that things are ok. Spend some time breathing long and slow from the belly and finding a comfortable position where the body can relax. ( Read ‘The Nervous System and Breath’ and ‘Spine Care.’ Healing occurs best when we give the mind and body the cues it wants to hear – ‘restore and nourish’ not ‘defend.’ If not: seek a professional opinion on how best to rehabilitate the injury and structure a return to your normal activities. This is where pain can establish itself into a pattern and become ingrained with our movements, putting more strain on the joints and muscles: it needs the right input to settle and allow things to heal and re-balance.
Chronic conditions - Making a change
When old injuries or habitual strains have been around for a while, we may need to focus on ideas to avoid pain building up too much, as well as some specific routines to put things back on the right track. If we start gradually and pace ourselves with regaining better movement and strength, the body will adapt to this new pattern and bury our memories of painful movement in favour of something more interesting!
Things to try:
Breath and Relaxation
Your body is great at healing itself, but not if it’s getting the wrong messages all the time… Find a position that you can get comfortable in – see ‘spine care’ for some ideas. Take some long slow breaths into your diaphragm – the belly, not the chest. Don’t force this, go at a rate that feels comfortable for you. Concentrate on the outbreath, if no one’s listening make them nice long sighs! You are attempting to give the mind and body as many cues to ‘let go’ of tension, pain and anxiety. ( Read ‘The Nervous System and Breath’ and ‘The Human Trampoline’) This is a window for it to feel safe and nurtured, open to change. Practice finding this state regularly – start with short little sessions and build them into your day. Before and after walks or exercise, difficult or stressful times…
Use whatever works: all your senses: smells, sounds and sights, memories of times you’ve been inspired by people, places, events… If you lose your concentration, that’s fine. Be aware of what took it, what that means to you, then let it go. Return to your breath – use it as an anchor.
Movement and Exercise
There was a time when we would quote the maxims of 40 minutes of exercise every day. Now the concentration is regular movement, don’t store it up for that 40 minutes that sometimes never quite arrives!
Walking is what we’ve spent 200,000 generations adapting to, it strengthens our bodies, even stimulates and massages our digestive system. Do it regularly, ideally with some pace. The key to nutritious movement is variety, at a level that our bodies can cope with and adapt to. But what about a body that is struggling to do what it used to through chronic conditions like back and hip problems? Use the ‘3/10 for effort’ rule – some movement that works at a non threatening level that the nervous system will accept as safe. Repeat it, build confidence, it becomes a 2/10 – now vary it, make it a little harder or keep going further… Challenge the system a little bit more once or twice a week, if it’s a little bit painful afterwards that’s fine as long as it settles within a couple of days ( if not, you just pushed a bit too hard; recover, modify and try again… ) Sandwich it with your breathing and relaxation and we have a window for change… I like the concept of ‘feel, play then load’ here to guide progression, we can always find ways to encourage further adaption, shining a light on the shady areas. ( Read ‘Anatomy – Structure and Function through the Myofascial Web’ )
Movement classes that focus on ‘mindful movement,’ form and breathing can be game-changing. Group exercise can be a great way to get engaged with exploring your movement with an experienced guide, and hopefully have some fun along the way. Yoga, Pilates, Qigong, Strength and Conditioning, Dance – if you don’t feel restricted by safety or pain, go for the one you’ve done least of to get the most profound change!! Mix it up, do something new… Have a look at the ‘local movement classes and venues’ for some ideas.
Sleep, nutrition, social support, or lack of it – this is important stuff in the world of healing. But life can get in the way right? Sometimes it’s hard to do all the best possible things, especially when we’re struggling with pain or disability… Start with small changes and try to fit good little habits into your daily routine.
We can start to use some of our bad habits as crutches to get us through low times. Awareness is the first step towards change here, talking is important too – find someone you trust and open up, difficult conversations can be the most rewarding ones…
Heat or Cold
As a rule of thumb, we tend to recommend cold to settle inflammation and swelling and heat to loosen stiff and tight structures…
Contrast hot and cold gives us more sensory input and can be good for issues like chronic low back pain where sensory feedback has been reduced for a long time. Be careful with areas of numbness, avoid extreme hot or cold as either can burn… 10 to 15 mins max for ice, heat packs can be used much longer, just check for excessive heat first…
There are some great braces out there which you can run hot or cold water through or insert packs into. Big lumbar or neck/shoulder re-useable packs are great for combining with pelvic tilts or easy head and neck movements.
Braces, Supports, Walking Poles
Even a tight fitting sleeve or top/tights around a struggling joint can help it get better sensory feedback and sometimes help with pain. It’s how myofascial taping works… With too much support over a long time comes weakening of an area and potentially more work to other joints which have to make up for the reduction in range of movement. There are some good products around and if they let you get some better function and be more active, great. Just be aware the body is always listening…
Walking Poles are a great option for struggling ankles, knees and hips, as well as poor balance – just be careful not to use your arms too heavily. I’d put the same caution at the end in terms of adaption, but safety – principally not falling over, comes first!
Bodywork - Massage & Manipulation
An experienced practitioner can use massage and joint mobilisations to restore movement and balance to the body. ( Read ‘Anatomy – Structure and Function through the Myofascial Web’ for more.) As a Physiotherapist I use evidence-based techniques, selecting which will be used for each client by their safety and suitability for that individual. I like to use these techniques to allow the client to develop their own body-sense, encouraging awareness and movement into the shady areas which have not been doing so well. It’s not about lying on the table and being ‘fixed.’
Relaxation and sports massages have their place too, touch can be a powerful therapeutic and management tool. Find someone you trust and be prepared to do some homework yourself!
Painkillers can help us safely quieten our pain responses and help us to carry on with our normal activities. Often over-the-counter medication will be sufficient for this, Paracetamol is the simplest and safest option.
You could also use anti-inflammatories like Ibuprofen. Use the full recommended dose and use them regularly, don’t wait until the pain is out of control. Usually you should only have to use them for a few days, perhaps a week or two. Do not use Ibuprofen if you are pregnant, asthmatic or have any stomach or digestive complaints.
Stronger painkillers affect the body’s own painkilling neurochemicals when taken for long periods. When reducing them we can expect some ‘withdrawal symptoms’ while the body remembers how to moderate things itself again. Ask your doctor for guidance if you are considering a change in your medication.