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Sprains

What and Why? 

Sprains are common and perhaps not completely avoidable, but you can limit the damage and get fully functional again days before most people do. You just need to be prepared — don’t wait for the next sprain to ask how!

The bony parts of your joints only do the mechanical work of hinge and load-bearer. They are firmly held together by tough fibrous ligaments shaped as sheets or ropes, that will not stretch along their length but can twist and bend freely otherwise. Additional stability is provided by the sinews through which your muscles pull on the bones nearby to move the joint and by the dense fibrous sheets that separate the muscles from each other and generally box everything up. Some of this sheeting surrounds the joint as a lining capsule, to seal into it the lubricant that oozes from the blood vessels on the surface of the capsule.

A sprain is an injury affecting the capsule or ligaments of your joint, leaving the bones and cartilages intact though perhaps bruised. In principle it can affect any joint, but those in your arms seldom are. They are not stiffly braced with ligaments since they do not constantly bear your weight; this makes them much more supple and mobile than joints in your leg and much more liable to dislocation.

Nevertheless thumb and finger joints are sprained quite frequently, usually by being forcibly bent backwards beyond their normal limit, but sometimes by a bruising blow. Your wrist is liable to a similar injury if during a fall your whole weight is thrown into bending it. Otherwise it is supple enough to cope with most contortions; your fingers are liable to be injured first.

Backache often arises from spraining of the ligaments in your spine or pelvis, but your hips are so massively surrounded by muscle that injuries likely to sprain them are usually strong enough to break them too. Your knees are also strongly braced, and more liable to cartilage injury. Spraining is serious when it occurs, and must be expertly treated for months to restore full stability.

Your ankles suffer the worst of both worlds. On the one hand they must be supple and springy like your wrists, to enable your feet to cope with uneven ground and absorb shock; on the other they constantly bear your whole weight. So they are quite hard to break, and very liable to spraining.

Usually your feet roll outwards, typically over the edge of a pavement or off the platform of a high-heeled shoe. The ligament on the outside of your ankle is stretched, and the capsule is often torn. It is bleeding from the blood vessels in this capsule that causes all the bruising and most of the swelling; this may not show until the next day, spread out over your foot and on your lower leg where the grease-proof layers of sheeting will allow it to surface.

By the second and third days after a sprain, inflammation has set in to begin the work of healing. This may stiffen considerably, and hurt more than the injury. The worst is over by the fourth day, but it will take another week to heal completely: ligaments are specialized for strength and are therefore rather slow to repair.

 

What can I do?

Advice to maintain and maximise your health

1. Prevent bleeding: As soon as you realize you have sprained your ankle, press firmly with all your fingers along the front outside quarter of the crease between your leg bones and your foot. Sit there patiently for ten minutes at least, however foolish you may feel, and do not allow yourself to be diverted. This will stop any bleeding from torn blood vessels and give them time to clot. These ten minutes greatly reduce the discomfort and inconvenience you will have to put up with over the next ten days.

2. First aid: As soon as you can, immerse your sprained ankle in cold water until it feels numb. Dry it, apply Arnica or Hamamelis (Witch Hazel) Ointment, and bind it firmly with an elastic or crepe bandage.

3. If you feel shocked or unsteady, take a dose of homoeopathic Arnica 30 (see homoeopathy) or Bach Rescue Remedy (see Bach flower remedies) — two or three drops of tincture in half a glass of water, sipped occasionally.

4. Dressings: You will need to re-apply the bandage twice each day. Repeat the bath while your ankle is painful or swollen, but start with three minutes in hot water before thirty seconds under the cold tap. You can repeat this cycle up to three times, but finish with cold. Then dry, apply Arnica or Hamamelis (Witch Hazel) Ointment, and re-apply the bandage. Use two bandages alternately if possible — the elastic recovers much better if it is rested between applications.

5. Comfrey appreciably accelerates the healing of bones and ligaments; the allantoin in it stimulates your white blood cells to work up to four times as fast without loss of efficiency; it is a pity they are only involved in a part of the effort required for healing! The herb is easy to grow and produces fleshy leaves and stems you can eat or brew for tea. The root is used to make tablets, but contains a trace of a toxic alkaloid chemical that accumulates in your body; therefore avoid using these for longer than a month or so at a time. A suitable dose is two tablets of Comfrey Root 400mg three times daily, with meals. Take Vitamin C 100mg with every dose of Comfrey tea or tablets, since your white blood cells will use even more of it than usual.

6.  When to consult your doctor: If after two days you still cannot put your foot to the floor, or the bruising is very severe, consult your doctor or hospital accident department to explore the remote possibility of bone fracture. Unless fracture is obvious from the beginning you will do yourself no harm by waiting, and save yourself unnecessary X-ray exposure. If you are in any doubt, at any stage, consult a doctor in any case.

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