Sprains, strains and suspected broken bones

Twisted ankles and sore wrists are common in sport and daily life. Most sprains heal with self-care, but some injuries are actually fractures. This lesson helps you tell the difference and act correctly.

Sprain, strain or break?

• A sprain affects a ligament around a joint, such as a twisted ankle; a strain affects a muscle. Both usually cause pain, swelling and bruising.
• The NHS says you may have broken a bone and need an X-ray if you heard a crack at the time, the part has changed shape or is at an odd angle, or it is numb, tingling or has pins and needles.
• St John Ambulance also lists severe pain, difficulty moving, a limb that looks shorter, twisted or bent, a grating feeling, and bone visible through the skin (an open fracture).
• If in doubt, treat it as a possible fracture until a professional has checked it.

Self-care for sprains and strains: PRICE

• The NHS recommends PRICE for the first 2 to 3 days.
• Protection: protect the injury, for example with a support or supportive shoes.
• Rest: stop the activity and try not to put weight on it.
• Ice: apply an ice pack or a bag of frozen vegetables wrapped in a tea towel for up to 20 minutes every 2 to 3 hours. Never put ice directly on the skin.
• Compression: wrap a bandage around it to support it during the day. Elevation: keep it raised on a pillow as much as possible.
• For the first couple of days, avoid heat (hot baths, heat packs), massage and alcohol, which can increase swelling.

Recovery and when to get help

• The NHS says most sprains and strains feel better after 2 weeks, but avoid strenuous exercise such as running for up to 8 weeks.
• Get medical advice if it is very painful or getting worse, you cannot put weight on it or walk more than a few steps, it is not improving with self-care, or you also have a high temperature or feel hot and shivery.
• Go to A&E or call 998 if you heard a crack, the shape has changed, it is numb or tingling, or the skin has turned blue or grey or is cold.
• Do not drive yourself to A&E.

First aid for a suspected broken bone

• Ask the person to keep still. Do not try to straighten or push a limb back into place.
• Support the injury above and below with your hands, cushions or rolled clothing to stop it moving.
• Do not move the person unless they are in immediate danger.
• For a possible arm fracture, a sling can support it. For a leg, keep it supported and still.
• Call 998 if they cannot move themselves or are in a lot of pain; otherwise arrange transport to hospital, and keep supporting the injury until medical help takes over.

Open fractures and shock

• If bone has broken through the skin, cover the wound with a sterile dressing or clean, non-fluffy cloth.
• Apply pressure around the wound, not on the bone sticking out, and secure the dressing.
• Call 998.
• Watch for shock, especially with thigh, hip or pelvis injuries. St John Ambulance says treat shock but do not raise an injured leg.
• Keep monitoring breathing and response until help arrives.