You’ve twisted your ankle.
Your knee is swollen after hiking up and down that epic 2,000 ft gain in 1 mile.
Your back hurts after gardening for 6 hours straight because you just had to get things done.
What happens after an acute injury?
How long is the pain going to last, and what should you expect in the next few weeks? What can you do to make things better? Should you do ice, heat, roll around in the snow, go soak in the tub? Should you move, stop, or something in between?
Read on and all your questions will be answered.
Healing is something that happens immediately after an injury, and your body starts the inflammatory process as well. Don’t know what that is? Check out my post on this here: Inflammation: the good, the bad, and the ugly.
This article is going to focus on injuries in your extremities because spine injuries are a whole different ballgame. Your upper extremities are anything from your shoulders down to your fingertips, and your lower extremities are your hips down to your toes. First things first, make sure you haven’t done significant damage. Check to make sure you can still move your limbs, and see if you can weight bear on your legs. If you can’t, especially the next day or the day after, you should be getting yourself to urgent care for an x-ray. For example the one point on Ottowa Ankle Rules (a checklist of symptoms) says that if you can’t bear weight through your ankle after you’ve sprained it, there’s a higher likelihood that you may have fractured something. If you have significant swelling, especially if there is pitting edema (when you push on your swelling and your finger indent doesn’t bounce back within a few seconds), that’s also something to seek attention for. If you’re having significant numbness, tingling, or loss of feeling in that area, get yourself checked out.
Okay, so let’s say the serious stuff is all out of the way, and you’ve twisted your ankle, or sprained your shoulder throwing that ball for your pup. Firstly, most of the time, the day of the injury, you’re going to feel pretty okay, a little sore, but not too bad. However, if you wake up the next day and feel worse, do not panic. This is completely normal. Overnight, your body has process things, a lot of that pain is from soft tissue swelling leading to stiffness with movement. At this point, Ice, Ice, baby. In fact, ice for at least the first48-72 hours, it’ll help decrease your inflammatory response (and although this is good, too much of a good thing isn’t great). Ice for up to 15-20 minutes at a time, and give yourself at least a 20-30 minute break between applications. Ice is meant to decrease blood flow to an area, i.e. vasoconstrict, but if you have it on for too long, it can actually increase blood flow, or be a vasodilator. During this time, elevate and compress if there is swelling, and give yourself relative rest to the area. Do try to maintain some light movement, but don’t push through pain.
For the next 4-10 days, the initial inflammatory response is going to subside. At this point, start really trying to move the limb gently, and without resistance. At this point, use pain as your barrier; pain is a good thing. It’s your body’s alarm system and will be your signal not to push too hard to fast. You can keep icing during this time as well, especially if your swelling is stubborn and does not want to go away.
After about 10-14 days, you’re now entering the subacute phase of the injury, meaning that the initial response has basically died down, and you need to get your tissues to start taking normal load again. This means, start moving! Start slow, with range of motion activities, again using pain as a boundary. At this time, it’s okay to push it a little, but be kind and patient to yourself and don’t go crazy. The first few days you start doing stuff, don’t be alarmed if your pain and swelling increase again. In fact, over the next few months, if you’re dealing with a lower extremity injury, your swelling will likely come and go as you increase activities. For instance, I had a pretty badly sprained ankle in grad school and was an avid runner at the time. For the next year after that injury, every time increased my mileage, my ankle swelled up for a day or so. It’s normal. Once your mobility has improved and is fairly painfree, get some resistance in there! Start walking a little more, light squats, lunges, and for upper extremity issues, try light weights. This can mean anything from dumbells, to soupcans or gallons of milk! Get your tissues loaded up so that they can heal properly. If you’re not sure what to do, or more specifically, what NOT to do, ask a PT! We specialize in helping people get back on their feet after injuries.
Normally, injuries take anywhere from 6-8 weeks to heal. This does NOT mean that you’ll be in pain for that long, but it will be a consistent healing process. Continue working within your limits and listen to your body. If you’re still having issues after 6-8 weeks, there’s a good possibility that you’re not dealing with secondary issues. Perhaps muscle tightness or joint mobility issues after the injury, or some compensatory mechanisms hitting you elsewhere; ask your trusted physical therapist if you have any issues!
