Light or deep pressure, muscle stretching, manually deflecting the muscle mass from its usual position with the hand or fingers by oscillatory motions, traction that attempts to increase the distance between the muscle's origin and insertion are all appropriate mobilisation techniques.

Harald Gaier

Harald Gaier is a registered naturopath, homoeopath and osteopath.

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Professional strapping or splinting provides physical support for the injured part, limits pain, assists or resists specific movements, and will allow the injured area to come gradually into use. It also helps relieve anxiety. Most common sites for use are ankle, knee, elbow and hand.

The application of cold packs, or cryotherapy, provides pain reduction, vascular constriction in the area, and a decrease in the metabolic rate of the cells undamaged by the initial trauma which are at risk from hypoxia due to vascular disruption (Arch Physical Med Rehab, 1964; 45: 233-238 and M Copeland-Griffiths, Dynamic Chiropractic Today, Wellingborough, Northants: Thorsons, 1991: 83, 170 and 181).

Blisters and haematomas should be aseptically aspirated, but the roof of the blister or haematoma must be left as it will act as a biological dressing (Arch Dermatol, 1968; 97: 717-721). To reduce the likelihood of reaccumulation of extravasated blood in a haematoma, a protective compress dressing (made of 15ml mother tincture of Digitalis purpurea to 500ml of water; or 10g of fresh Digitalis leaves to 1 litre of water) should then be applied (Med Klinik, 1965; 60(50): 2028). An ointment of Hypericum perforatum can be applied to the blistered area to reduce discomfort and speed the healing process (Lehrbuch der Phytotherapie, Gothenburg: ab Arcanum, 1988: 296-297).

Minor strains, where there is muscle fibre damage only but the muscle sheaths remain undamaged, need cooling followed by a compress of nettle spirit (made from both Urtica urens and dioica) or a moist Arnica montana dressing (15ml mother tincture to 500ml cold water). Onion compresses, made from finely chopped onion mixed with some water and a little salt, are very useful for pain relief (Lehrbuch der Phytotherapie, Gothenburg: ab Arcanum, 1988, p 345). Medium strains, where there is partial rupture of sheaths as well as fibre damage, need additional professional strapping to allow the affected part to come gradually into use. Controlled, early mobilisation can lead to successful rehabilitation. Major strains, that involve complete rupture, need hospital treatment.

Sprains are overstretch injuries to ligaments and tendons. Complete ruptures, which are often surprisingly pain free, need surgery. Excessive motion of a joint is evident and the examiner may feel a gap. It is the partial tears that are excruciatingly painful. Treatment is as for minor strains that is, cooling and a compress or moist dressing. But rest is essential and achieved best by a fortnight in a splint.

Heat collapse occurs in any sportsman or sportswoman who feels unwell or collapses with a rectal temperature of more than 38¡C (100.4¡F). The victim needs tepid sponging, fluids to drink and their legs elevated. Studies have shown that oral rehydration with saline is as effective as intravenous rehydration (J Appl Physiol, 1997; 82: 799-806).

Two other studies show that caffeine consumed in a carbohydrate electrolyte solution during exercise does not cause diuresis or adversely affect bodily hydration status (Int J Sports Med, 1997; 18: 40-46) and a meal plus water can be more effective than a sports drink alone in restoring whole body water balance (Eur J Appl Physiol, 1996; 73: 317-325).