This guide will help you decide your next actions for the recovery of your pain and movement dysfunction immediately following an injury.
You will find first aid advice, below. Please take special heed of neck injuries advice, below.
If your injury happened, or pain began, more than 3 days ago, you should review the information here and then follow advice beginning here.
General Injury First Aid
In any case in which an injury has prevented the ongoing participation in your work, sport or activity at the time of injury, the injured part should be rested in a position higher than the heart, an ice pack should be applied for thirty minutes at hourly intervals, and a compression bandage applied if relevant for the body part: RICE.
PAIN. See general advice for management according to pain levels, below. The severity of pain can be measured on a pain scale of 0 to 10 where zero is no pain and 10 is the worst pain. Measure as immediately before taking the next dose of pain medications.
1-3 = mild pain; 4-6 = moderate pain; 7-10 = severe pain. Due to the variability of pain at times of day, activities or rest, you can rate your pain under different circumstance and make a drawing or graph of the change of pain. How to draw your pain.
A useful guide is a person with a pain of:
10/10 may go unconscious,
9/10 may scream but not be able to speak more than single words;
8/10 groaning, unable to move the part;
7/10 distressed by the pain, moving, not able to do tasks;
6/10 very distracted by the pain, able to do habitual tasks;
5/10 aware of and distracted by pain, only able to do light tasks with difficulty;
4/10 aware of pain, a little distracted, able to do all light tasks, unable to do heavy or fast tasks;
3/10 aware of mild pain, not distracted, able to do most functional and work tasks to 50% full speed and strength;
2/10 aware of mild pain, able to do all tasks with to 75% or more in speed and strength;
1/10 a vague sense of pain, able to do all functional tasks at 90 - 100% of full speed and strength).
NECK INJURY
Apply the following rules to a neck injury incident. For neck pain without an incident, see below.
Pain 1-3/10 - Mild - Apply a soft collar
Pain 4-6/10 - Moderate - Lie down, Stay still. Have someone apply a soft or rigid collar. Call an ambulance.
Pain 7-10/10 - Severe - Stay lying down and still. Have someone call the ambulance. Don't allow anyone to move your neck to apply a soft collar. Someone could, very gently, hold under the neck for pain relief until the ambulance arrives to apply a rigid collar.
See first aid, rest and support instructions for specific body regions and limbs, below.
See rest and management guidelines according to pain levels
See further specific instructions for:
Neck; Shoulder; Elbow & Hand & Wrist;
Thoracic & Lumbar ; Hip & Knee
Foot & Ankle
Wrap the ice pack over the injured and swollen part.
Tie the ice pack in place and rest with the part elevated for at least half an hour and as long as you can.
Repeat at hourly intervals for 3 days.
Wrap from below the injury or swelling, spiralling the bandage by overlapping about 1/3 until above the injury or swelling.
Re-do the bandage whenever loose.
Wear the bandage for 2 - 3 days or until you can weightbear on the injured part or use it 50%.
See taping and support for specific regions.
Upper limbs - elevate on pillow in lying, elevate on pillows on table in sitting.
Lower limb - elevate on pillows in lying.
Mild Injury: During an activity you felt pain that didn't stop you continuing the activity, however, later, espcially after resting a while, you found it was becoming difficult to move easily and there is some pain. There may be mild swelling. Sometimes the swelling and stiffness and pain is only evident the next day.
While not needing to stop all activity, use the RICE guidelines as much as possible over the first 2 or 3 days:
Rest: Be active until you feel the pain is worsening e.g a dull ache may begin to be a distracting throb. Rest from the activity and fully support the injured area e.g sling, cushioning.
Ice: Apply a cool pack to the injured and swollen part for half an hour, every two hours, with the part in elevation.
Compression: If there is swelling, tape or bandage the part. See taping guide.
Elevation: Place the swollen part above the level of the heart to prevent and reduce swelling.
Returning to Activity. Use the injured part in activities only to the degree you can control the movement e.g walk even if a limp, lift without moderate effort and pain.
Day 4 - 7. Past day 3 also see self-guided rehabilitation. Use taping if there is swelling and pain on movement.
Weightbear as much as you can.
Commence gentle exercises of the part.
Day 8 onward, the pain should be 2/10 and the part may feel stiff. You can increase your activity to match mild to moderate discomfort.
Pain and movement recovery can take 2 - 4 weeks.
Moderate Injury: During an activity you felt a moderate to severe pain that had you cease activity, even drop an object or fall down. You are unable to recommence the activity due to pain and weakness. You notice immediate swelling or difficult to move the body part. Some injuries occur to a part of the body that will not show swelling externally. The swelling will occur as a resistance to movement or posture.
Immediately and strictly observe the RICE guidelines and continue for 3 days.
Rest: Apply support and keep resting in lying in elevation with cushioning if needed to provide comfort. Use a sling or crutches to maintain comfort of an arm or leg injury. Older persons might use a walking frame or wheelchair, and additional personal care.
Ice: Apply a cool pack to the swollen part for half an hour and repeating every hour, with elevation.
Compression: Apply a compression bandage where possible. Re-do the bandage whenever it loosens.
Elevation: Maintain the part elevated above the heart continuously except for necessary activities such as ablutions and meals.
Apply taping or light compression bandaging to any body part that has swelling.
Use pain relief medications that you know you can take safely.
Avoid activities or movements that are more than mildly painful and, then, only as necessary.
Use stronger support where necessary e.g sling for shoulder pain, crutches for leg, ankle or foot pain.
Progression past day 3 with self guided rehabilitation.
Recovery can take 4 - 6 weeks
Severe Injury: During an activity you feel severe pain, you are unable to continue the activity or move the part of your body or even move about at all.
You will not be able to deal with your pain, yourself.
You require immediate assistance, support and first aid.
If possible, others should call an ambulance or seek immediate medical attention for you.
If noone is immediately nearby, lie as still and comfortable as you can. Call out for help loudly or, if possible, use your mobile phone to call for help.
You will need medical assessment including an x-ray or scan to see whether you have broken a bone or ruptured a tendon or ligament.
Even in the case, diagnostics are not able to confirm a fracture or rupture of soft tissue, if the pain is more than 7/10 without pain medications OR the limb feels unstable or very weak, a rigid splint support is indicated e.g Richard splint for a knee, or a sling for an arm.
See a physiotherapist as soon as your doctor allows.
Self guided rehabilitation guidelines may help once the pain is below 6/10. However your personal doctor and physiotherapists advice will take precendence.
Recovery can take 6-8 weeks
Wear collar during sitting or standing.
If the pain persists in lying, try the collar for sleep as well. You can also wrap a towel around your neck for support in lying.
After 2 days, leave the collar off until pain begins to return or increases. also perform gentle neck ranging exercises.
Each further day leave the collar off for longer periods providing pain is not severe, until you no longer need it.
Also use for an acute locked neck or spasm that happened during sleep or on rising from bed.
Neck Injury Rehabilitation
If there is neck pain and restriction of movement without obvious incident, for moderate pain, you can rest at home with neck support until you can get up easily. Seek medical attention if you are not able to get up after 2 days.
Use sling for up to three days after onset of severe pain.
After two or three days, start removing the sling for periods of time, until the pain increases to moderate discomfort.
Shoulder dislocation. Keep the shoulder in the sling for two to three weeks. If the second or more times dislocated, keep in sling for 4 - 6 weeks to ensure healing and re-tightening of ligaments.
Rotator Cuff Injury. Use Fixomull or Rock tape alone or as a protective underlay for more rigid sport-tape. Tape as in diagram above. Sit with elbow resting on a table about a hand span away from the body, elbow forward of shoulder about 20 degrees. Place one end of sport-tape just in front of the lateral of the upper arm. Person draws shoulder blade back. Pull the tape firmly over the shoulder and blade to near the spine. Repeat with another piece of tape, overlapping the first by one half width. Use a short piece of tape to anchor off each end. Leave on for 3 days. Remove if skin becomes itchy.
Shoulder Rehabilitation
Whenever there is swelling, bandage:
Elbow in a slightly bent position.
Wrist in a straight or slightly extended position.
Redo the bandage whenever loose.
Wear the bandage for 2 - 3 days.
In moderate and severe pain use a sling for pain relief when moving about. The sling should support the arm through the elbow and forearm, and have the elbow at a right angle to aid the resolution of swelling. When not moving about, remove the sling and support the arm away from the body, in elevation if possible.
After 3 days, if pain or swelling continues, use taping until sweling has resolved.
Overuse Forearm Injuries. Acute pain in the forearm muscles with a lot of repetitive effort requires rigid taping to support the muscles and tendon attachments to the elbow (see image above). Rest hand on a roll and tape from mid forearm up to past the lateral elbow bone.
Elbow and Arm Rehabilitation
Avoid pain inducing activities especially bending, for two or three days.
If pain is moderate to severe when upright, rest in lying during this time. If sitting, ensure comfortable support and avoid slumping in lounge chairs.
Lumbar spine pain is often more comfortable in standing and, in that case, walk for 5 minutes every hour.
If there is pain on sitting or standing and it is difficult to maintain a straight back, Tape the lumbar with the person lying on front (prone). Tape from the lower ribs to the sacrum (below buttock dimples) with 4 to 6 strips of overlapping tape. See diagram above.
Thoracic Spine: tape the upper back with a criss-cross over the painful area. Tape in sitting and person sits tall and draws shoulders back during taping.
Progression. Double walking time every 2 days until back to normal walking and standing time periods.
Thoracic Rehabilitation
Lumbar Rehabilitation
If Knee ligament Rupture is supected or the Patella (knee cap) has been dislocated wear a Richard Splint (image above) over the compression bandage, until a further doctor review.
RICE 2-3 days in all cases of injury. For moderate and severe pain, reduce mobility to necessary activities such as toilet, shower, meals.
If unable to bear weight on the painful leg, use crutches or a walking frame and mimic the pattern of normal walking.
Increase the weight as able, until fully weight bearing through a flat foot.
Hip Injuries will usually show up as pain in the groin. It won't show the deep swelling that is occuring.
Knee pain and swelling:
Immediately banadage as image above with knee slightly bent.
When weightbearing and swelling 90% resolved, use tape support.
Hip Rehabilitation
Knee Rehabilitation
RICE for 2-3 days. Apply compression bandage with the ankle in a square position. Use Reduce mobility to necessary activities e.g toilet, shower, meals.
Crutches or walking frame if unable to weightbear, and mimic walking.
Increase weightbearing within moderate pain, until able to weightbear through a flat foot.
Use crutches until can fully weightbear when walking without.
When weightbearing and swelling is 50% resolved, use rigid tape support as image above.
Ankle and Foot Rehabilitation