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Compression therapy in rehabilitation

Compression therapy is crucial in reducing swelling and improving circulation in the limbs, particularly post-surgery and after sports-related injuries. Its application even extends beyond the medical sphere to the veterinary world, where it is a recognised therapy for racehorses and, increasingly, after small animal surgery. Nevertheless, its primary use is in human medicine.

Compression therapy forms an essential part of the treatment for many soft tissue injuries. Many people know it by its mnemonic: RICE (or sometimes PRICE). Individually, the letters stand for: rest, ice, compression and elevation - and the "P" in PRICE is protection. Of course, the precise treatment for any injury to soft tissues depends on the severity of the injury, but milder injuries, especially strains and sprains, can often be treated safely at home.

Strains and sprains are common injuries that frequently occur during sporting activities. They are soft tissue injuries because they affect muscles and ligaments, rather than bones. For clarification, a strain is the stretching or tearing of muscle fibres. It often occurs when muscles are stretched past their limits. Backs and legs (especially hamstrings) are common sites for strains. Pain is usually the most immediate signifier of damage - and this can occur when the muscle is at rest, as well as when it is in use. Swelling, reddening and bruising may also be evident. In addition, muscle spasms and weakness or other loss of function in the affected area can be a problem.

Meanwhile, a sprain refers to the twisting, tearing or stretching of a ligament. It usually results from the application of excessive force on a joint. Ankles, knees, wrists and thumbs are all prone to sprains. As with strains, pain is often the first symptom of a problem. Swelling, tenderness and bruising may also develop, and using the joint normally may be impossible. Note that if bruising occurs, it will not necessarily be confined to the area immediately surrounding the damaged joint. This is because blood can leak along nearby muscles until it reaches the top layers of the skin.

Severe pain, total inability to use the affected area, a crooked appearance to the damaged joint or muscle, and numbness, coldness or discolouration are strongly suggestive of the need to seek medical help from a GP, walk-in clinic or minor injuries unit. This is because the strain or sprain could be particularly severe, or it could even be a fracture. If none of these risk factors are present, it is generally safe to try RICE. However, remember that if there is no improvement within a few days, it is wise to seek medical advice.

Rest

This is largely as it suggests: it means reducing physical activity and certainly avoiding exercise. A walking stick, walking poles (the type that some hikers use) or even crutches can help an injured person achieve minimum necessary levels of mobility without compounding the problem, and they are particularly helpful if weight-bearing on the affected area proves impossible. A sling may be used to support an injured shoulder, but this must be applied correctly to avoid further discomfort and to ensure it is properly supportive.

Ice

Although ice must be used with care to avoid the added discomfort of an ice burn, it can be enormously soothing and it really works to reduce swelling. As a general rule of thumb, an ice pack should be applied to the injured area for no more than 20 minutes. The ice pack can be reapplied after two or three hours. Remember to wrap it in a towel or similar to keep it away from direct contact with the skin. A packet of frozen peas or other freezer goods works well as a substitute for an ice pack.

It is essential not to leave ice on an injury on any part of the body for too long. This is due to the constricting effect that ice has on blood vessels. The result of this will be to reduce the flow of blood to the affected area, which will delay healing and also potentially damage the skin (an ice pack burn). It may also, of course, be a rather unpleasant sensation to endure. As a general rule, no injury should be iced after 24 hours from when the injury was sustained. The only exception to this ought to be if a doctor or other qualified medical professional orders icing an injury to relieve pain or to reduce persistent swelling.

Compression

This means using elastic compression bandages, or similar, to reduce swelling. General advice from the NHS is that the bandages should be used during the daytime only. The bandages or wraps should not be too tight, as this can cause further swelling and compound the existing problem. Without some first aid knowledge, it is not always easy to tell if a bandage is too tight, but numbness, tingling and increased pain are indicators that it ought to be loosened. So, too, is swelling below the bandage. If in doubt, consult a pharmacist or medical professional for further advice. It should not be necessary to compress the area for more than 48 to 72 hours. Seek medical advice if the need for compression appears ongoing after a maximum of 72 hours has elapsed.

Elevation

Keeping the injured part raised above the level of the heart can help to reduce swelling.

In addition to RICE, over-the-counter painkillers, such as paracetamol and ibuprofen can be used (unless they are contra-indicated for a particular individual) to ease pain and reduce swelling. Various topical creams may also assist, and a pharmacist can advise further.