(1) To limit the traumatic effusion (swelling), and so restrict the amount of “Sticky” blood fluid in the tissue spaces. This is achieved by applying a pressure bandage to the injured part. A calico or crepe bandage is used over several layers of cotton wool, each layer being compressed by turns of bandage; it is essential that the turns cover the injured part adequately, and extend well above and below it. In general calico bandages are used when treating joints and crepe bandages when dealing with muscle injuries.
Strapping should not be used to limit traumatic effusion in the early stage of injury; it may produce an uneven, cordlike compression, which may increase the effusion. It should be noted, however, that when an injury does not appear to be of a severe nature, and it is considered essential for the individual to continue to use the injured part, an elastoplasts strapping is used instead of a pressure bandage. The principle of allowing an injured player or athlete to resume activity immediately after an injury is basically unsound, and should not be accepted by the trainer or therapist unless he is acting on medical advice.
Ice-Cold Water. When pressure has been applied the injured part may be immersed in ice-cold water for about 10 to 20 minutes; if immersion is not practicable the bandage may be soaked, the water being applied with a sponge for the same length of time. The wet bandage is then removed, and a new pressure bandage applied. The cold water relieves pain, and may help to check effusion by causing a local constriction of the capillaries.
Local Injections of Hyaluronidase. In recent years many doctors have used local injections of hyaluronidase to accelerate the dispersal of traumatic effusion. The injections are used in conjunction with the other forms of physical treatment mentioned in this section.
(2) To prevent movements which might stretch or strain the injured structures and so (a) cause a recurrence of the bleeding, or (b) pull the ends of the torn fibers apart and so hinder repair. This aim is accomplished by supporting the damaged structures with the pressure bandage in such a way that they are completely relaxed, and then to resting the injured part. The type of rest required will depend on the severity of the injury; in injuries of the lower limb it may vary from complete rest in bed with the limb raised on pillows (to assist circulation and aid drainage of inflammatory exudates) to semi-rest, e.g. walking with crutches without taking weight on the injured limb. la injuries of the upper limb a triangular sling may be used to provide rest.
(3) To relieve pain. To a certain extent this aim is achieved by the measures which are taken to fulfill the previous aims pressure, support, cold applications and rest. In addition some type of pain-relieving drug (e.g. aspirin) may be prescribed by the doctor. It should be noted that when rest in bed is required for an injury of the lower limb a considerable amount of discomfort and pain is often experienced if the bedclothes are allowed to rest on the limb. A bedclothes support should be improvised by putting a large cardboard box or a pile of books on the mattress at the foot of the bed.
