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When we suffer an acute joint sprain it is immediately painful, swollen and limits function. The inflammatory process is in full swing here over the next 3-5 days and its purpose is to destruct and remove all of the debris from the damaged tissue, and provide cells that lay down scar tissue. The body is extra efficient at this process, therefore we must control the degree of inflammation with the RICE regime and sometimes resort to the use of medications.

Non steroidal anti-inflammatories (NSAID’s)

Are a class of drug that serves to limit the excessive inflammation that generally occurs with acute injury. In cases where inflammation is prolonged for greater than 3-5 days the NSAID action is desirable as it reduces the amount of bleeding/swelling and sensitization of the pain nerve endings in the damaged tissue.

In some injuries early use of NSAID can be counterproductive in that it blocks the early inflammatory process which in turn limits the production of scar tissue. Without a strong scar, the damaged tissue has now got an obvious weak point, and prone to re-injury. This is especially the case in muscle strains, and it is for this reason that we tend to avoid prescribing NSAID’s in the initial stages post injury.

The effects

NSAID’s can be applied topically via a gel however this has only been shown to penetrate 15mm beneath the skin surface. Systemic NSAID’s in tablet form include celebrex, naprosyn and voltaren. Although the tablets are very effective at reducing pain and inflammation, they are systemic, which means they effect the entire body and prolonged use can cause gastro-intestinal and kidney problems.

Used appropriately, NSAID’s can be an important component in the rehabilitation process. Doctors tend to prescribe a course of tablets over 1-2 weeks, however this is avoided in the first 3-5 days post acute injury. If pain and inflammation persist past 1-2 weeks of regular NSAID use, introduction of a local cortisone injection may be considered into the inflamed tissue.

Other treatments

Other forms of treatment that are aimed at reducing inflammation include cryotherapy (ice), compression, elevation and some electrotherapy modalities. Your physiotherapist will utilize these less aggressive approaches during the first 3-5 days post injury in order to ‘control’ inflammation and not remove it completely. Just the right amount of inflammation for a nice strong scar, is a fine balance and will be guided by your physiotherapist.

Shane O’Sullivan

Sports Physiotherapist
Prahran Sports Medicine Centre