People who immediately reach for anti-inflammatory medications following a sprain or strain injury could be hindering their healing and risking further damage.
That is the view of University of Otago lecturer in clinical pharmacy practice Dr Rhiannon Braund, who says there is little evidence to support the belief that early aggressive use of such medicines delivers a faster return to activity.
She prescribes a return to the old-fashioned use of RICE (rest, ice, compression and elevation) to treat strains and sprains.
If pain relief was required she advised paracetamol because it had few side effects and did not affect the healing process in the same way as the various anti-inflammatory medications people were choosing to use.
There was a point to swelling around injuries, she said.
"It acts to limit the amount of damage done, by preventing bleeding and immobilising the joint. It's no coincidence you feel stiff and sore. This is the body's way of asking for rest so it can get on with the job of healing."
Dr Braund said the acute inflammation phase lasted only 24 to 48 hours, but this was also the time when people reached for the non-steroidal anti inflammatory drugs (NSAIDS) including ibuprofen and diclofenac (aspirin-containing medications also fall into this group).
While it was thought use of these medicines meant a faster return to activity, recent studies had shown if they were used too early they reduced the inflammatory response and might delay acute healing, slow muscle regeneration and could compromise long-term healing.
Bleeding at the injury site might also be increased.
Dr Braund said one of the difficulties with NSAIDs was that because they were available in supermarkets, people felt they must therefore be safe.
Accordingly, people often neglected to seek advice from health professionals, such as pharmacists or doctors, and failed to read and heed the labelling on packets, which was of "pretty high standard".
Dr Braund pointed out that recommending medication was considered outside physiotherapists' general scope of practice.
There was also a tendency for people to use the NSAID medicines for other conditions such as headaches when, unless there was some type of inflammation involved, they would be no more effective than paracetamol.
People needed to be more aware of what they were taking in terms of supermarket medicines, generally.
Lemsip, for instance, was often regarded merely as a hot lemon drink, but it contained paracetamol and if people were taking other medicine containing paracetamol they needed to ensure they did not exceed the maximum safe daily dose.
RICE treatment
• Rest: Reduce the length of time spent moving the affected joint, preventing further damage.
• Ice: Apply for up to 20 minutes every two hours for the first two or three days. This relieves pain and minimises blood flow to the area. Ice and pressure are more effective to control swelling.
• Compression: Minimises swelling and limits joint movement, reducing further damage.
• Elevation: Decreases risk of fluid accumulating at the site of the injury. In the first 24-48 hours after injury use paracetamol for pain, with codeine if necessary.
- Dr Rhiannon Braund, University of Otago
