How to treat sprains and bruising following the principles of PRICE and METH.
Medically reviewed by Dr Juliet McGrattan (MBChB) and words by Claire Chamberlain
If you’ve had an unexpected fall or twisted an ankle and you’re in pain, you may be understandably worried. While a sprain or bruising is usually not serious and can generally be treated at home without the need to see a doctor, both can cause pain and loss of movement, as well as swelling and discolouration.
But what exactly is a sprain an bruising – and importantly, what can you do about them? Read on for our self-help guide to easing sprain pain and bruising:
What is a sprain?
A sprain happens when you damage a ligament (the band of tissue that connects two bones together), usually by over stretching or tearing it. An awkward movement, such as going over on an ankle, is the most common cause of sprains.
During the sprain, the small blood vessels and fibres in the flesh burst, causing blood to enter the surrounding tissue. This results in swelling and the blue, bruise-like discolouration.
How to treat a sprain
Unfortunately, a sprained ligament goes hand in hand with a certain amount of pain. To help make you feel more comfortable and to lessen the risk of any further damage, there are several measures you can take.
The first is following the principles of PRICE: Protect, Rest, Ice, Compress and Elevate. while the second is following the principles of METH: Movement, Elevation, Traction and Heat.
The PRICE method to treat sprains
The PRICE method involves taking the following steps, to help ease pain and lessen the damage caused by the sprain:
It’s important that you protect the injured area from further damage. Don’t carry on exercising with a sprain. Avoid weight bearing on a leg sprain and use a sling to protect a wrist injury.
Putting your feet up is important after incurring a sprain, to ensure healing occurs as quickly as possible. Ideally, you should rest the injured area for at least one or two days, because internal bleeding can continue for up to 24 hours. If possible, the sprained area should be kept straight – a wrist, for example, can be supported in a sling. Try to keep the injured area in the same position while you are sleeping, perhaps by placing a couple of pillows under your sprain.
Cooling the damaged area is a good way to reduce swelling and limit the bleeding. The following are good cooling options:
- Ice cubes in a plastic bag
- A bag of frozen peas
- Custom-made cooling packs
In each case, wrap the cold bag or pack in a towel before placing it on the sprain (always ensure there’s a piece of fabric between your skin and the coolant, otherwise your skin may get cold damage). It’s a good idea to cool the skin for 15 minutes, stop for 15 minutes, then cool again, and so on. Be careful if you are diabetic, as circulation can be reduced and skin sensation numbed. You may not therefore be aware of damage caused by excessively cooling the skin. Check with your doctor before using ice packs if you think this applies to you.
Compressing the damaged area with bandages will help to prevent movement. Speak to your pharmacist for advice about which bandage to use.
If you are wearing bandages, it’s important to monitor the area surrounding them. If this becomes blue-coloured and the surrounding tissue seems cold, you should remove the bandages and contact a doctor.
The injured area shouldn’t point downwards, otherwise fluid build-up may occur. This prolongs the healing process and causes more pain.
The METH method to treat sprains
METH works by following a set of slightly different principles, which you can put into place after you have finished the PRICE treatment. It works by encouraging blood flow back to the area once healing has started, to speed up recovery.
Start slowly, with some gentle flexion and extension exercises, to help bring movement back to the area.
It’s important to continue elevating the area when at rest, to avoid swelling. For example, if you have sprained your ankle, when sitting at a desk or on the sofa, prop your foot up on a stool or chair.
Traction involves the manipulation of the joint by a qualified physiotherapist. Once your injury is well rested and healed, a visit to a physiotherapist can be a good idea, as they will be able to provide advice on how to strengthen the weakened area.
Applying heat to the area can help to encourage blood flow to the area, thereby encouraging healing. Try a microwaveable wheat pack, and don’t apply heat for more than 30 minutes.
PRICE or METH: which is best to treat sprains?
So, when should you use the principles of PRICE, and when should you use METH?
‘Whether you use the PRICE or METH method depends on the type of injury you have and how long you have had it for,’ says Dr Diana Gall, GP at Doctor4U. ‘You may combine both methods in the recovery process at different stages.’
When to use ice
‘New sprains and strains should always be treated with ice in the first instance to reduce swelling – you mustn’t use heat in the first couple of days, as this could cause further swelling,’ says Dr Gall. ‘Once the swelling has gone down, you may use heat to ease sore and tight muscles.’
When to use heat
Heat is used more for chronic conditions, whereas ice should be applied to new or sudden sprains.
‘Heat and movement will increase blood flow to the injured area, which will help with the healing process, but this shouldn’t be used right away,’ says Dr Gall. ‘There will be swelling in the first couple of days of injury, and applying heat and pressure to the sprain through movement will only increase this swelling and delay healing. When the swelling has reduced, this is a good time to apply the METH method gradually and gently.’
‘While you’re in pain, you’ll need to rest the injury, but If you’re not in pain or the pain has stopped, you should try to move around to avoid stiffening of the muscles and joints,’ adds Dr Gall. ‘However, keep your movements light, as strenuous exercise can cause further damage to the injury. You can try soaking in a warm bath, which is effective for deep muscle pain, or you can apply a heat pack to the injury, but do keep it at a comfortable temperature to avoid burns.’
Pain relief for sprains
If you’re struggling to cope with the pain caused by your sprain, you can try over-the-counter painkillers, such as paracetamol. Ask a pharmacist for advice on which painkillers are suitable for you.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, used to be frequently recommended following a sprain, because they reduce the inflammation and swelling, as well as relieving pain.
However, inflammation is a necessary part of the healing process. It limits movement to prevent further damage to the joint and also initially helps to repair the damaged tissue. There is now some suggestion that reducing inflammation with this type of painkiller can actually slow down the healing process in the long-term. It’s considered best to avoid these types of painkillers in the first 24 to 48 hours after the injury.
When to see a doctor about a sprain
While most sprains can be treated at home, you will need to consult a doctor if you experience any of the following:
- The sprain is accompanied by severe pain and severe swelling.
- One of your jointsgives way and is unable to carry your weight.
- The pain is still present and getting worse after two days.
- The sprain has not improved after four days of self-treatment.
How to treat bruising
As with the swelling that occurs after a sprain, bruising is also caused by bleeding underneath the skin. Depending on its severity, a bruise can be very tender at first, as well as swollen.
To help ease the pain and swelling associated with bruising, you can treat it in much the same way as you would treat a sprain:
✔️ Apply an ice pack (wrapped in a tea towel or similar) for 15 minutes at a time, to help reduce the swelling and stop the bleeding.
✔️ Elevating and resting the area can also help to relieve pain and help fluid drain away from the bruised area, reducing swelling.
✔️ After several days of icing, resting and elevating, gentle heat can be applied, which can help to improve blood flow to the area, ease tension and soothe pain.
When to see a doctor about bruising
Bruising following a bump or fall is natural, and any bruises should disappear on their own after two weeks. If your bruising is particularly painful and swollen, and has not gone within two weeks, visit your GP for advice.
You should also see your GP if you suddenly start developing bruising for no apparent reason, or if you have been in a more serious accident, to check for internal bruising to organs, tissues or bones.