PhysioMonkey

[edit: reposted 4/7/06 as new info re anti-inflammatories added] 

Most injuries will be minor and may not even affect your ability to continue with whatever.

Here are some photos from a friend

• Unicycle injury.  This was a basic "turning" of the ankle.  You can see the aftermath being a decent amount of swelling, bruising, some pain and this one caused problems with walking.

• Another unicyle injury.  This was a "leg meets Muni pedals" incident.  Just some cuts with little bleeding.  It didn't need any treatment beyond some ego-massaging oohs and aahhs.

• This was a snakeboard injury.  Eye meets pavement!  Some swelling and bruising. 

Basic Advice

DO get R.I.C.E.

• Rest - Stop putting any pressure on the injured area.  If you've turned your ankle don't go for a 10km joggle.
• Ice - Whack an ice pack on it.  Don't make it too cold and don't leave it on for more than 10 mins.  The old favourite is a bag of frozen peas - be careful with this as modern freezers are far too cold for this purpose.  Wrap the bag in a thin and slightly damp towel - if the dampness starts freezing then it's too cold.  DON'T use ice if you have heart disease.  If you start to get chest pain whilst using ice then stop using the ice and go and see a doctor.
• Compression - Use a compression bandage if you have one.  Good chemists should have them.  These are often referred to as "supports"; they are not.  They simply restrict the amount of swelling.
• Elevation - If possible put the affected bit up above heart level.  Have a lie down.

DON'T do H.A.R.M.

• Heat - People like warmth but these injuries don't.  Heat promotes swelling by opening up the blood vessels in the vicinity of the heat.  Don't do it for these injuries.
• Alcohol - 2 reasons not to drink after an injury.  Firstly; if you get tipsy you're more likely to hurt it more as you drunkenly stumble away from the bar!  Secondly; the alcohol acts as a vasodilator (opens up the blood vessels) so making swelling worse.  (Incidentally this is why rescue dogs in the alps don't carry brandy - it would lead to hypothermia).
• Repeating - if you've just tried something which caused an injury don't do it again.  Does this seem too obvious?
• Massage - firstly this will be painful if someone is putting pressure on an acutely swollen area.  Secondly it also acts as a local heater leading to more swelling.  Thirdly if the tissues are badly injured then it might not take much to damage them further.  This advice relates to acute injury (ie within the first 24-72 hours post-injury)

There has been some controversy about whether NSAIDs (Non-steroidal anti-inflammatories) such as Ibuprofen and Diclofenac should be used after a recent injury.  The positives were that they reduce swelling and hence relieve pain.  The negative was that the swelling is actually rather important to healing so stopping it happen would slow down your recovery time.

Recent evidence is leaning towards the suggestion that taking NSAIDs does not really slow down healing that much.  Here's a quote from "Nonnarcotic Analgesics in Short-term Pain: Musculoskeletal Disorders" by Dr J Markenson in his review of lots of studies about this topic.

Accumulating evidence suggests that they neither delay healing nor interfere with the repair of soft tissue or cartilage following acute injury. Furthermore, in the nongeriatric population, the use of NSAIDs as short-term therapy appears to be associated with neither short-term nor long-term side effects.

This has changed my practice.  I'd previously given the advice to avoid NSAIDs.  Now I'll tell people that there has been controversy but it's leaning towards this view.

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