(1) To disperse the traumatic effusion, i.e. (a) to spread the free blood fluid into the surrounding tissues, so that it mil be drained away by the uninjured lymphatic vessels and veins, and (b) to assist the drainage of any excess amount of synovial fluid . This aim is accomplished by the use of strapping and various forms of physiotherapy.
Strapping. The injured part is strapped firmly and the player encouraged using it as normally as possible; in injuries of the lower limb this usually includes walking. The pressure of the strapping on the moving muscles and joints acts as a most efficient form of auto-massage, which improves the circulation and the lymphatic drainage of the part.
To increase the effect of the massage the strapping may be applied over a pad of adhesive felt, which is positioned over the injured tissues.
Two types of strapping may be used: (a) Zinc oxide adhesive plaster, and (b) Elastoplasts combined with supporting strips of zinc oxide plaster. Support is necessary until the traumatic effusion has been completely dispersed; this may take anything from two or three days to two weeks or more, depending on the severity of the original injury.
Protecting the skin. The skin is often sensitive to the adhesive spread, or may be irritated by the strapping being changed frequently, as when daily massage is given. To protect the skin the strapping may be applied after the injured part has been covered by a few turns of ordinary cotton bandage, which has been previously soaked in cold water. The strapping must overlap the bottom and top edges of the cotton bandage by about i to I in., so that it is securely fastened to the skin.
When using elastoplasts another method of protecting the skin may be tried. The non-adhesive side of the strapping is applied to the skin; the reinforcing strips of zinc oxide plaster are then arranged over the adhesive surface. Any areas which are left uncovered are powdered with talcum powder to make them less sticky.
Joint injuries. In dealing with a joint injury which is associated with a large synovial effusion strapping is not used. A pressure bandage is applied to the joint, the injured limb is rested, and the controlling muscles exercised by static contractions and other non-weight-bearing exercises which do not cause movement of the affected joint.
Physiotherapy. Massage, exercises, contrast baths, faradic stimulation and anodal galvanism may be used to disperse the traumatic effusion. Two or more of the treatments are generally used in combination, and the choice depends on individual preference and the stage of recovery. In the early stage, for example, anodal galvanism, faradism and contrast baths may be employed; later, massage and exercises.
(2) To prevent movements which might stretch the damaged structures and break down the delicate repair tissue which joins the ends of the torn fibers. This aim is achieved, as far as possible, by arranging the strapping so that it holds the injured tissues in a relaxed position. With many muscle injuries this is not practicable, and the therapist has to support the affected muscles in a circular manner, and instruct the player not to put them on the stretch.
(3) To assist repair. The aim is accomplished by the measures which have been previously outlined for improving the circulation and preventing the damaged structures from being stretched. Some form of heat therapy may also be used to improve the blood supply of the injured part-short-wave diathermy, infra-red radiation, radiant heat or hot packs.
(4) To strengthen the muscles of the affected part, especially those which may have been injured. The player practices some simple remedial exercises which do not stretch the damaged structures or require too much muscular effort; in practice this means exercising within the limit of pain.
(5) To maintain the normal range of movement of the joint or joints of the injured part. This is done by using exercises of the type suggested above. Unless the joints are exercised their movements may be seriously limited by the formation of thickenings and adhesions.
