In this current climate, there is a lot of uncertainty.  Without access to traditional healthcare provision, we are having to adopt a ‘make do and mend’ attitude.  This includes learning to deal with our own health problems from behind closed doors.

Inevitably, injuries will continue to happen daily as we adapt to our new indoor lifestyles.  Although we typically see a lot of football and gym-related injuries in clinic, we also see a huge number of injuries sustained at home.  These include ankle sprains, muscle strains, back spasms and posture-related injuries.

I’ve put together a few tips and tricks that you can try to self-manage your musculoskeletal injuries until the corona-cloud clears and you’re able to have a traditional physiotherapy appointment again.

Ice vs. Heat

As a physio, I’m constantly asked “which is better for injuries – ice or heat?”  The truth is that both serve their purpose at different stages of injury.  Think of it this way:  Physiologically, ice causes vasoconstriction or decreased blood flow, which helps to reduce swelling, inflammation and pain. Heat on the other hand, causes vasodilation, an increase in circulation, making it ideal to soothe muscle tension and reduce joint stiffness.

Ice

Ice is great for acute pain, usually during the first 48-72 hours post-injury, where the area has become red, inflamed, hot and swollen.  This includes injuries such as ankle sprains, a newly strained muscle or bad bruising.

You can easily make a DIY cold pack by wrapping ice cubes or frozen peas in a wet tea towel.  Alternate the ice pack on for 10 minutes and then off for 10 minutes to reduce swelling and inflammation.  Never place ice directly on the skin to avoid ice burns. 

Heat

Heat is more useful that many people realise, mainly because muscle can be a big pain-generator.  Muscle also happens to respond well to heat.  Muscle pain that is dull in nature, as well as persistent pain caused by osteoarthritis, cramps, spasms and trigger points (muscle knots) can be successfully managed using heat.

Heat is a cheap, safe and effective way of managing these common musculoskeletal injuries.  I often tell my patients to use heat to warm up a muscle prior to stretching, as warm muscles respond better to stretching than cold muscles.

Ways to apply heat at home :

• Have a hot bath or, in the shower, let the hot water run onto the injured area
• Apply a heat pad or hot water bottle to the affected muscle.  Keep the heat source on for 10-20 minutes and then stretch
• (If you don’t already have a heat pack and with Amazon running on skeleton staffing, you can make your own at home.  Fill a sock halfway with rice or buckwheat, sew the top closed and microwave for 30-60 seconds until the rice has warmed up.
• Be aware of causing burns – never put heat or ice directly onto your skin

Important: only stretch a muscle as far as comfortable.  Do not push through the pain.  Breathe, relax and stretch until you feel a mild pull on the muscle.  Hold this stretch for 20-30 seconds.  

Be cautious using ice or heat of you have diabetes, peripheral neuropathy or reduced sensation, to avoid causing burns. Additionally, never use heat where you suspect there may be swelling or infection as heat draws more blood to the area and will exacerbate the inflammation.

P.R.I.C.E. Management

Hundreds of people sustain acute injuries every day that can be treated effectively at home using the P.R.I.C.E. method. (P.R.I.C.E. stands for Protection, Rest, Ice, Compression and Elevation).  This is ideal for a trauma such as falling, twisting or knocking into something. P.R.I.C.E. management is excellent for injuries that are immediately painful, swollen, red or bruised.

Use the P.R.I.C.E. principles for the first 48-72 hours immediately after injury.  The goal during this time is to control swelling, prevent tissue damage and reduce pain.  Acting quickly after an acute injury can improve long-term recovery.

Painkillers – to take or not?!

At the time of publication, the latest advice is to avoid taking ibuprofen if you are showing any signs of coronavirus as it may exacerbate symptoms

Traditionally, non-steroidal anti-inflammatories (NSAIDs) have played an integral role in the treatment of acute injuries.   As a physiotherapist, I would often advise my patients to take over-the-counter anti-inflammatories such as ibuprofen to help reduce pain, spasm and inflammation. However, there has been a lot in the news this week about the potential for ibuprofen and other NSAIDs to aggravate COVID-19 symptoms.  The WHO (World Health Organization) now recommends that people suffering COVID-19 symptoms should avoid taking ibuprofen, after officials warned that NSAIDs could worsen effects of the virus.

(Read more here: https://www.bmj.com/content/368/bmj.m1086)

Source: https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/ Accurate as of 18th March 2020

It is important to note that inflammation plays an essential role in the body’s natural healing process.  Inflammation causes a rush of blood cells to an injured site.  This influx of nutrient-rich blood helps to promote healing by repairing damaged tissue.  Without inflammation, tissue repair is not possible.  While NSAIDs are effective at reducing pain, those pain signals are part of your body’s natural protection mechanism. Your brain interprets pain signals as caution, in other words, you experience pain to prevent further injury.

In a pre-corona world, there was already a growing body of evidence warning against using NSAIDs for acute injuries.  Now more than ever, please be cautious with taking any non-steroidal medication.

Consider using either paracetamol (not an NSAID), or using alternative methods to protect the damaged tissue and promote circulation (see P.R.I.C.E. Management).

Exercise

NHS guidelines state that everyone should aim to be physically active every day. With most of us adjusting to a new indoor lifestyle, this has become far more challenging.  But on the upside – we’ve all been given the gift of time, so no excuses, people!!

Although your usual workout class or gym is temporarily closed, now more than ever we should all be including exercise into our daily routines.  Top physicians have advised that looking after our bodies and keeping healthy are important ways to combat coronavirus.

Keeping physically active, sleeping 7-8 hours a day, hydrating and eating a balanced diet are crucial to keeping up the body’s resistance to infection.

Although sport and exercise opportunities are currently limited, try to avoid staying sedentary all day. Try some YouTube exercise classes, do some yoga or go for a walk or a run outside. There are loads of free resources on the internet to facilitate exercising at home.  The NHS has some good guidelines and links, and is a great place to start:  https://www.nhs.uk/live-well/exercise/

Stretching is one of the most important things you can do to protect yourself against future injury.  Equally, if you are already injured, gently stretching will help to prevent further muscular tightening. Stretching helps to warm the tissues by increasing blood flow and oxygen, which in turn makes muscles more receptive to being gently lengthened. When your muscles and connective tissues are more supple, they can more easily absorb and distribute the repetitive shock that running and high impact exercise subjects them to.  This boosts the efficiency of muscles, ligaments and tendons, thereby improving performance.

Benefits of stretching

• Prepares the body for exercise
• Maintains and increases flexibility
• Improves posture, joint mobility and performance
• Decreases the risk of injury while improving body awareness

Decreasing the risk of injury is crucial, now more than ever.

Speak to a physiotherapist for specific exercise advice to self-manage your injuries from the comfort of your quarantined home.

Posture

In a pre-corona world, I saw an awful lot of adults, teenagers and even children with posture-related pain. With the UK hurtling towards a Europe-style lockdown, many of us will find ourselves spending time working awkwardly from our laptops and indulging in lengthy box-set binges. Unfortunately, I anticipate that lockdown will mean a surge in the number of posture-related injuries.

The answer? Prevention is better than cure!  Make sure to create an ergonomically sound workstation at home – see image below.  Ideally, sit upright with your feet on the floor, screen at eye level and your back well-supported.  Similarly, consider your sitting posture before starting a Netflix binge, or Zoom meeting – your post-corona body will thank you!

To read more about obtaining perfect posture, click here:

Video Physiotherapy Appointments

In lieu of traditional physiotherapy appointments, we are currently offering video consultations.  We are obviously unable to provide the usual hands-on treatment including massage, mobilisation and acupuncture.  However, some 1:1 advice and a tailored exercise programme can go a long way to help with self-managing pain.  Please be in touch if you would like to book a virtual appointment.

 

Finally – remember the mantra of modern medicine: prevention is better than cure! Stay fit, do some gentle stretches and exercise, look after yourself and stay safe.

Take home messages for self-managing injuries at home:

• Stay as active as you possibly can whilst self-isolating
• If you are unlucky enough to injure yourself at home, consider P.R.I.C.E. management as well as ice/heat
• Avoid taking NSAIDS including ibuprofen if you are showing any signs of COVID-19
• Prevention is better than cure – warm up before and after exercising
• Be aware of your posture and avoid sitting without moving for long periods
• We provide video physiotherapy consultations – please be in touch for specific injury advice and exercises to get you back on your quarantined-feet ASAP
• Stay safe!

To discuss your pain or for video appointments, please contact us here:

Naomi Burns

Lead Physiotherapist

24th March 2020