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Introduction to Treatment of Injury

INITIAL TREATMENT OF INJURY

Other than minor cuts and abrasions, the next most frequent injuries encountered in soccer are sprains and contusions. Sprains can occur when ligaments in a joint, usually of the ankle or the knee, are stretched or partially torn due to a quick twisting or stretching movement that forces the joint beyond its natural limits. Contusions, or bruises, can occur when an area of the body suffers a muted blunt force trauma, such as being kicked by a foot or struck by a knee.

In both cases, sprains and contusions, the tissues of the body become separated and fluids rush into the area, causing pain and swelling. It is the arrival of the bodily fluids, mostly blood and lymph, that need to be controlled immediately upon injury and up to at least 48 hours thereafter. Ironically, these fluids, which are ultimately essential to the healing process days later, cause further separation of the tissues upon their arrival right after the injury, meaning increased damage and pain.

For immediate on-field treatment, in order to decrease the damage from the swelling, and to reduce the pain, coaches should remember the acronym “r- I-C-E.” This stands for “rest, Immobilize, Cold, and Elevate.”* The capital letters emphasize the importance to promptly ICE the injury.

Rest means to stop activity immediately and to get the heart rate back to a normal resting state as quickly as possible. It also means to not use the injured area or to put weight on it.

Immobilize means to use an elastic (“Ace”) bandage to keep a joint from moving (sometimes a splint may be appropriate). It also means to apply gentle compression. This must not be applied too tightly because it can cut off blood circulation.

Cold means to apply ice (or a chemical cold pack) to the affected area. APPLYING ICE IMMEDIATELY AFTER THE INJURY IS THE SINGLE MOST IMPORTANT AND EFFECTIVE TREATMENT TO REDUCE GREATER DAMAGE. This is why the biggest reminder in “r-I-C-E” is “ICE.” Ice should be applied approximately 20-minutes at a time, with approximately 20-minute breaks in between applications, for up to 48 hours after the injury. Caution must be taken not to apply the ice directly to the skin because the skin could freeze. The ice should be in a plastic ‘zipper” bag (gallon-size) with a thin towel, a piece of cloth, or the elastic bandage, used between for skin protection. Ice should be applied in this alternating manner for at least 24 hours. This is the minimum amount time the body needs to seal up torn capillaries and the intercellular breaks that are the sources of other bodily fluids. Continued application of ice for at least another 24 hours is recommended, but is dependent upon the extent of the injury.

Elevate means to raise the injured area above the level of the heart. This has the double effect of allowing the force of gravity to not only keep more fluids from going to the injured area, but to also drain existing fluids away from the injury. After ice, this is the second most important and effective immediate treatment for sprains and contusions. To do this for a leg injury, a player almost always needs to lie down flat with the leg up. A player’s leg can be elevated by resting it on a cooler, a kitbag, or even a bag of balls.

The prompt application of ice to an injury is so important that coaches should have ice available with them at every practice and every game. Players, and parents of youth as well, should be instructed about the importance of using ice. Players should also be instructed to inform the coach immediately upon receiving an injury so that it can be treated properly. Out on the field, proper treatment usually means getting the player to lie down on the grass, well away from any activity, so that the injured area can be elevated and ice applied. It is highly recommended that coaches never allow themselves to be at practices or games without another responsible adult present, in order that injuries may be handled properly without having to take attention away from the other players.

Similarly, players and parents alike should be instructed to avoid the old temptation of applying heat too soon. Where the application of heat, usually in the form of a water bath or a heating pad, ultimately promotes and even speeds up healing, it does so by drawing blood to the site of the injury. Only after all swelling has stopped, there is no increase in pain, and there is no evidence of any increase in the extent of the injury, should the application of heat be considered. Consideration of applying heat should never be given within the first 48 hours of the injury. Applying heat too soon will bring bodily fluids to the area and make the injury worse. If there is any doubt about whether or not to apply heat, it should not be done.  Once heat is applied, if swelling or pain returns or increases, stop using the heat and immediately return to applying cold.

Notes: 1.) Nothing in this article is intended to supplant then seeking professional medical help after an injury. Serious injuries require the services of doctors. 2.) The control of pain and swelling can also be helped by the use of an anti-inflammatory drug containing “ibuprofen.” As with all drugs, whether over-the-counter or prescribed, they should only be taken if they are known to be safe and then, only according to the directions. 3.) Chemical cold packs, which use an endothermic reaction to absorb heat, last 20-minutes or less. Chemical cold packs can be used in succession, but having sufficient ice on hand is a better treatment. 4.) Once a player is home, parents may utilize ice massage (ice frozen in paper cups circled over the injury), re-usable athletic cold packs, or even bags of frozen peas.

See Water Kit for Games for a method to ensure that ICE is available.

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*In the original “RICE” construct, the “C” stood for “compression.” Whereas compression is important, cold is paramount.

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John Harves
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