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Self Care Treatment of Injuries, part 1

by Stacey Kaplan LAc, LMT

What do you do when you think you've sprained an ankle?  Why isn't the swelling going away after an injury?  How can you make that bruise disappear?
Often times we are unclear what to do when we sustain an injury.  Sometimes RICE (rest, ice, compression, elevation) just doesn't do the trick.

Over the next few newsletters I will be discussing various ways you can effectively identify an injury, the best first aid choices and how to treat chronic injuries. 

This month, I'll begin by detailing how to examine an injury. A critical first step in figuring out which therapies need to be applied.

How to examine an injury:

PAIN is usually the first sign that something is wrong. Is the pain;
Mild- Can disappear with activity, does not prevent you from exercising, does not keep you awake at night, and massage and application of liniments are enough to keep the pain from getting worse. It is not uncommon for the pain of early stage tendinitis to lessen or disappear with activity. If mild pain is chronic it may be worth getting it checked out to prevent further damage.
Moderate- Does not disappear with activity, can impede performance, and does not prevent sleep. Often mild pain increases to moderate over time.
Severe- Stops activity, is not alleviated with over the counter painkillers, interrupts sleep, and may feel nauseating. This should be examined immediately by a physician. This is the type of pain often associated with bone breaks or torn tendons or ligaments.
Radiating- Pain that spreads out to other areas or down the leg or arm. This means that there is an impingement on a nerve. This can come from muscular tension or from a more direct pressure on a nerve such as a bulging disc. Often the radiating pain of sciatica is caused by muscular tension in the back or of the piriformis muscle. Radiating pain can be serious. It is worth checking in with your doctor.

Deformity- look for obvious deformity.
Compare sides; are the bony landmarks, joint creases and muscles on the affected side in the same place as the unaffected. Marked deformity accompanied by pain is a good indication of a serious problem. Don't risk moving the injured part; immobilize and seek help immediately.
Find out exactly where it hurts. Sometimes X-rays do not reveal obvious difference that can be seen with the naked eye.
Bruising- Bruising is a sign of ruptured blood vessels in a local area. It may be black, blue, green, yellow or a combination of colors. It is best to treat bruises right away to restore proper blood flow.
Swelling- Swelling indicates stagnation of blood and/or fluid and the possible presence of inflammation.
Pitting swelling: A swollen area with depressions in it, especially after applying slight pressure. This can indicate a deeper level of swelling often associated with fractures or severe sprains, although sometimes can result from an internal imbalance that causes water retention.
Swelling that pushes outward on a contained area: Common in sprains where blood and fluids from ruptured vessels have accumulated in the local area.
Hot, red swelling: Indicates inflammation and accumulation of fluids and qi.
Cotton-like swelling: Looks and feels mushy or cottony. Often indicates a fracture.
Body symmetry- Look at the symmetry of both sides of your body.
Look at relative shoulder and hip heights. A raised hip can indicate that your back is tighter on one side which can contribute to ankle, knee and hip problems.
Do your knees roughly line up with the shinbone and ankle. or do they fall inward or outward? Imbalances in the musculature of the legs can cause pain and lead to injury.
Is your range of motion equal on both sides? Decreased range of motion can indicate a problem.

Touch the injured area gently and lightly, gradually go deeper.
If there is a specific area of tenderness on the bone and swelling, there may be a fracture.
If the area feels hot to the touch, there is probably inflammation.
If the area feels cold, there is probably reduced circulation in the local area.

Does the pain increase or decrease with movement?
What kind of movements hurt; do stretching or contracting the muscles cause pain? Torn or pulled muscles often hurt when stretched.
Check range of motion of the injured limb and compare it to the uninjured side. If you know what movements help or aggravate the problem, you can narrow down what structures are involved.
Does the area pop or crack when moved? If you move and touch the area you may feel that something slips or clunks in one part of the range of motion. Often we assume this means we have arthritis. Instead, it can be a misalignment in the musculature that causes tendons to slip in and out the the track they operate on in the joint. Gentle manipulation and corrective exercises are used to treat this.
Immobilize the area if there is massive swelling and deformity and seek medical help.

Specific treatment strategies will be discussed in future issues.

Whatever your injury, Chinese medicine advocates immediate treatment. Treat minor problems promptly and they are much less likely to develop into larger, chronic conditions.