KidStuff

RICE Will Suffice As First Aid For Common Sprains & Strains

By Paul M. Marz, M.D.

Winter is now in full force. The cold, the ice, and snow everywhere. So that means the kids are outside sliding down anything steep or on anything slick that goes fast. Aah, the season of joint injury is here again.

So now our teary child has limped/hobbled up to us to report that this arm/leg/foot/wrist isn’t working right.

What to do?

If the bone is broken, you will clearly know it as the site of the pain will have an unexpectedly new joint. (More subtle fractures may not be so clear, but that is not the scope of this article. If it is one of the subtle types, a few days will not matter as long as the hand or foot downstream of the injury is pink and most of the fingers and toes wiggle.)

Most of these other injuries can be sorted out right away as sprains or strains.

It’s a sprain when ligaments are injured by being stretched beyond the normal range of motion. A strain is when muscle fibers tear for the same reason. Tendons fall in the same sprain category as ligaments IF the tear or damage is not near the tendon/muscle junction.
Most joints are made up of many components: Bone, the hard stone part of the body; Ligaments, which act more like rigging to hold the bones in proper alignment working together correctly as a joint; Tendons, which act as cables that pull the bones to move the joint; and Muscle, the motor that provides the power to cause the motion.

Both strains and sprains are graded in severity so people in the medical industry know just how bad the joint is damaged. They range from Grade 1, the least severe, to Grade 3, the worst.

Some add a Grade 4, but here we just call it a break and send in the Orthopedic specialist.

In Grade 1, you have pushed the joint to the max but nothing is broken, everything is still tight and intact, although there is pain.

In Grade 2, there is evidence of an incomplete tear. Something gave a bit, there is extra motion in the joint and a bit more bleeding into the surrounding area. This will take a while to tighten up again, but it will heal almost as good as new. If the child continues to grow, it also will be good as new soon.

Grade 3 is not so good. The part that gave out is gone, broken, popped, or torn. There is clear extra motion in the joint, but not a lot of pain. Why no pain for a worse injury? That’s because when you put pressure on an injury, it hurts. When it is torn through, each end is free, so no pressure, and hence no pain. This injury is hard to explain to parents as the joint is looking bad from the outside, but not much pain on the inside. This will require surgical repair.

What can you as a parent for Grades 1 or 2…and Grade 3 until you can see a doctor?

Just remember my favorite mnemonic: RICE, and it has nothing to do with diet.

R: Rest the joint. If it hurts, stay off it!  Nature is telling you what to do;

I: Ice, to make it cold. This shrinks the tissue and helps stop the bleeding. Apply an ice/cold pack for 15 minutes or so three or four times a day. Remember we want it cold, NOT FROZEN!!  Do not give your child frostbite!!  Cold doesn’t mean frozen, Check the skin often to prevent this painful result.

C: Compression, an Ace wrap helps limit swelling from fluid as well as slowing bleeding. Remember that toes and fingers MUST BE PINK or it is too tight. Too tight for too long and the sprain/strain is the least of your problems.

E: Elevate the injury. It will swell less, hurt less, throb less. It makes the patient feel better…and it is cost-free and simple to do.

Of course, some injuries are not so easily treated this way. so use common sense or call your doctor.

Each grade heals at its own pace with Grade 1 healing the fastest.

So now you are a little better prepared for that first crash or sled accident. Try to let the patient sit a few minutes and get over the initial injury before taking a look. The RICE system should handle 95 percent of injuries until your patient can be seen by his physician. And don’t hesitate to call your physician if you have any doubts or questions.