South Platte Sentinel Wednesday, May 1, 2013 Page 15Health

On Fri., May 3 American Legion

1602 W. Highway 6

Homecooked DinnerAvailable for purchase before Bingo

Phone (970) 522-1447Fax (970) 522-1605

101 W. Main St., Sterling

Local People......Trusted Name

AnnHernandez Pharmacist

We MailPrescriptions!

This week we will be discus-sing a common injury that is often misunderstood and often misquoted as a source of injury. Thefirstthingweneedtodiscussis some basic anatomy. A ligament is connective tissue made largely of collagen that connects a bone to a bone. A tendon is a piece of connective tissue that connects a muscle to bone and transmits movement. When a ligament is injured we refer to it as a sprain, and when a muscle or tendon is injured, it is referred to as a strain. Using the knee for example, sprains can be divided into three groups. A grade 1 sprain is an injury in which the ligament is injured but not torn in such a way as to allow excessive movement of the bone. A grade 2 sprain is the ligament is torn in such a way that the bones more than they did previously, or more than they are expected to (called hypermobility). And a grade 3 sprain is a complete rupture of the ligament between the two bones. Grade 1 sprains typically last 7-10 days, grade 2 sprains last 14-21 days generally and grade 3 sprains also last 21 to 30 days but can result in permanent instability of the joint. Often with proper care a Grade 2 sprain can “shorten up” during the healing process through specificpositioning of the joint. Let’s use the example of a medial collateral ligament sprain of the knee. A grade 2 MCL sprain does allow excessive movement when tested. However, if the knee is immobilized in slight flexion, theligament has time to shorten during the healing process and regain some of its stabilization ability, decreasing the excessive movement resulting from the sprain. This immobilization can essent-ially decrease the severity of the outcome and improve the results of the healing process. When the joint is not properly allowed to heal, the opposite can occur. Ligaments which might have been sprained only partially, such as a grade 2 lateral ankle sprain, can be converted into a more serious injury due to the lack of proper care, what we used to call “running through the sprain” in the olden days. Running through an injury like

this is an ill conceived notion that by preserving and providing excess movement, that we are somehow allowing the joint to heal when, in fact, it is exactly the converse excessively stretching and twisting the grade 2 sprain, can lead to increased levels of injury longer lasting pain and disability as well as permanent instability of a joint. Running through an ankle sprain is never a good idea. We were taught to “walk it off” when we suffered an injury. This ill-conceived notion is akin to the running through an injury and always results in a longer, more poorly healing injury. This advise of walking off a sprain should never be heeded as there is no meritorious value in walking off an injury. This seems to have arisen from the idea that walking off an injury made someone somehow “tougher” and therefore that the injury wouldn’t bother you as much. However, nothing could be further from the truth. A grade 1 ankle sprain, which would normally heal in 7-10 days, can still be painful and limiting at 30 days if the injured patient attempts to walk off and play through this injury. The reason for this is that you continually reinjure the ligament providing multiple opportunities for the same injury to start healing all over again. So instead of a 7-day injury, you have three 7-day injuries consecutively resulting in a patient who is still hobbling around at 3-4 weeks with a grade 1 sprain. Strains can be a bit more ambiguous when attempting to grade the severity of the injury. Of course, testing the specificmuscles is a very accurate means to identifying the specific muscleor tendon involved and once this can be identified throughpain and/or weakness or both, specific immobilization techniques,application of therapeutic modalities and other treatments can be applied. With strains, a minor strain may hurt more than a severe strain, simply because the tendon in a rupture may no longer hurt to contract. A good example of this would be the supraspinatus tendon of the rotator cuff. When a Grade 1

strain of the supraspinatus occurs, a patient has severe pain when attempting to abduct the arm. However, in a grade 3 strain, the tendon is torn completely and, therefore, may not hurt at all, it simply may not provide any stabilization force. Clinicians must be wise in evaluating strains as they are tricky in this fashion. In both cases of strains and sprains, proper evaluation and management techniques are key to proper treatments and healing times. In treating sprains and strains, the “RICE method” - rest, ice, compression and elevation - should be observed. Rest is obvious, not abusing the joint injured, ice applied for 10 minutes taking care not to frostbite the skin twice an hour, compression using an Ace wrap, vet wrap or other compressive device taking care not to compromise circulation and elevation or raising the limb above the heart to reduce swelling. In addition, the letter “P” should be added to the RICE method for treatment of sprains and strains -that is “protection.” Often a protective splint or brace is useful in minimizing the excess movement that occurs during the healing period and therefore, the RICE method becomes the PRICE method - protect, rest, ice,

compression and elevation. For more information on the treatment of sprains and strains or to receive a basic evaluation of your joint injury, please call the clinic in Sterling, Haxtun or Fort Morgan for a no cost assessment. Visit our facebook page at McDonald and Keil Physical Therapy Center.

There is a difference between a sprain and a strainPhysically Speaking

ByDr. MarkMcDonald

(Dr. Mark McDonald, PT, DPT, OCS is a lifelong Sterling native and board certified orthopedic physical therapist with 21 years practice in Sterling. He is a clinical partner with AB Fitness/Alma Blagg, Devonshire Acres, and Northeast Plains Home Health Care in Sterling.)