Ahead of the game: Sports & wound care

Managing sports injuries correctly, using the proper protocols and appropriate dressing, can enhance wound healing and support a speedy recovery

Australia is a nation of sports lovers. In fact, 80% of Australians agree that sport is a major part of Aussie culture. Yet while participating in sports can be beneficial for our health and mental wellbeing, it can also result in sports injuries.

According to St John Ambulance Australia, the most common sideline (minor) sports injuries include head and neck wounds, sprains and strains, as well as eye injuries.

Pharmacist Angelo Pricolo, from Tambassis Pharmacy in Brunswick, Victoria, says pharmacists are in a unique position to deal with simple wounds and sports injuries.

“Pharmacists have access to a wide range of dressings, an understanding of the healing process and often a knowledge of any medication the person is taking. All these things play a role when it comes to healing time or indeed whether healing takes place at all.

“As pharmacists, we need to look at what stage the wound is at, whether it’s infected or needs to be referred to an allied healthcare professional.”

He says there are lots of wound care products out there, but the problem is that they’re not always used appropriately. “Customers need a fair bit of advice, which in my opinion has to start with an assessment of the wound.”

When assessing a wound, it’s important to consider the following five factors:

  • Tissue colour and type: Is the tissue necrotic, granulating, showing signs of infection or macerated?
  • Wound exudate: Infected wounds often produce heavy exudate, which can be toxic to the surrounding skin. Choice of dressing should be determined by the level of exudate.
  • Wound edges: The area that extends from the edges of the wound can indicate the stage of wound healing. Wound edges that are coming together and contracting are signs of healing, for example.
  • Pain level: Pain should be assessed before, during and after dressing or bandaging, and may be a sign of infection or further damage.
  • Size/shape/depth: The location, depth and shape of the wound will determine dressing and treatment choice.

Mr Pricolo says, “The thing with wound care is that you need to make an assessment of the wound before you can decide on the appropriate dressing, and that’s where the pharmacist really comes in.”

health worker bandaging an elbow

Principles of wound management

As with all areas of healthcare, pharmacists are encouraged to take a holistic approach to wound care. Whether you’re dealing with an eye injury, a skin tear or an ankle sprain, it’s vital to look at the person as
a whole.

Associate Professor Geoff Sussman OAM explains, “We shouldn’t view wound management as the application of a dressing to an acute or chronic wound. Wound management is, and must be, an holistic approach to the patient to ensure best practice is applied in treatment. This approach is best expressed as ‘treat the whole patient and not just the hole in the patient’.

“There are some simple rules for the management of minor wounds, which includes decontamination, cleansing, haemostasis, wound closure, and selecting an appropriate dressing. The major objective is to facilitate optimal healing; that is, with as little scar tissue as possible, with a good cosmetic appearance.

“Therefore, to treat an acute wound you should first clean it. All traumatic wounds have some form of contamination from major to minor, so it is very important to remove any dirt, foreign material, potential bacterial contamination from the wound before closure and dressing. Then, if necessary, the wound edges should be held together by strips or tape, and finally an appropriate dressing applied.”

While traditional theory has always held that wounds should be kept clean and dry so that a scab may form over the wound, it’s now acknowledged that wounds heal better in a moist environment.

“We want to avoid letting the wound dry out to form a scab. This is one of the most important basic principles of modern wound healing. Wounds covered by an occlusive dressing do not form a scab, so epidermal cells are able to move rapidly over the surface of the dermis through the exudate that collects at the wound/dressing interface. The application of a totally occlusive or semi-permeable dressing to a wound can also prevent secondary damage as a result of dehydration,” explains A/Prof Sussman.

Indeed, skincare is an important part of wound management and prevention. Moisture is an essential component of skin healing and maintaining a healthy skin barrier. Therefore, as part of the wound healing process patients should be encouraged to clean and moisturise the periwound skin to help prevent dryness, which can cause skin cracks, sores and redness, potentially leading to infection.

Common sporting injuries: sprains and strains

Sprains are one of the most common sporting injuries. According to Sports Medicine Australia, sports such as basketball, volleyball, netball and football, where there are frequent twisting and turning movements, along with tennis and hockey, are particularly vulnerable to ankle sprains.

When it comes to recognising the signs and symptoms, sprains are graded on a scale of one to three—mild, moderate and severe—with grade one and two sprains most likely to present to pharmacy.

Symptoms of mild to moderate sprains can include:

  • minimal to moderate pain;
  • moderate instability of the joint;
  • poor balance;
  • swelling and stiffness;
  • pain with weight-bearing activities;
  • bruising and inflammation may be present.

The most common treatment approach, which can also be used for muscle soreness, is to apply the RICER protocol:

  • Rest—rest the patient and the injured part
  • Ice—apply an ice pack or cold pack for 15 minutes every 2 hours for 24 hours, then for 15 minutes every 4 hours for 24 hours
  • Compression—apply a compression bandage firmly to extend well beyond the injury
  • Elevation—elevate the injured part
  • Referral—to a GP or physiotherapist if warranted.

To help speed up recovery, the No HARM protocol can also be applied:

  • No Heat, as this can cause swelling
  • No Alcohol
  • No Running or other exercise of the injured area, as this may cause further damage
  • No Massage, as increased blood flow can encourage swelling.

Peter LeCornu, former CEO of St John Ambulance Australia, says when bandaging a sprained joint, such as an elbow, knee or ankle, it’s important to give the right support. He advises how to wrap an ankle, using the figure eight method, but says the same method can be applied to bandage an elbow or knee.

To bandage someone’s ankle, use a roller bandage.

  • First, you need to hold the ankle in a comfortable position, with the joint slightly bent.
  • Start by putting the end (tail) of the bandage on the inside of their ankle. Pass the bandage over and around to the outside of the ankle, and go around one-and-a-half times, so that the tail end of the bandage is firmly covered and won’t come loose.
  • Then make a figure-of-eight around the joint, wrapping the bandage diagonally above and then below the joint.
  • Keep going with the figure-of-eight, but each time, only cover about two-thirds of the previous layer, so that with each new layer you’re covering a third of new skin.
  • Once you’ve done this several times, wrap the bandage straight around the ankle a couple of times, and then fasten the end using a safety pin, sticky tape or by tucking it in
  • As soon as you’ve finished, check their toes for circulation by pressing their big toenail for five seconds until it goes pale. If the colour doesn’t come back within two seconds after you stop pressing, the bandage is too tight; you’ll need to loosen it and do it again. Their ankle could keep swelling after you’ve bandaged it, so keep checking their circulation every 10 minutes.

Addressing eye injuries

Sports-related eye injuries (often the result of sporting equipment, fingers or balls) can cause a wide range of wounds including haemorrhages or lacerations, corneal abrasions, retinal detachments and hyphaema.

According to Sports Medicine Australia, the three main types of sporting eye injuries are:

Cuts or scrapes to the eyelids—these are typically caused by fingers or fingernails and usually present with redness and pain.

Blunt trauma—this usually refers to a blow to the eye area from a fast-moving object, such as a ball or racquet. This type of injury can cause external bleeding and bruising, as well as broken bones around the eye socket.

Penetrating injuries—where a foreign object or body penetrates the eye.

The advice from St John Ambulance is that immediate first aid is essential to decrease the risk of infection and potential vision impairment or loss. When addressing lacerations to the eye, which have caused bleeding, it’s important to apply dressing with minimal pressure to the eye area.

In cases where there is a foreign body in the eye, such as dirt or debris, the object can be dislodged with a clean, soft wet cloth, gauze or cotton bud. If this is unsuccessful, a saline rinse can be used to flush out the object.

It’s essential to acknowledge injury to the eye can interfere with the interplay between the production of lacrimal fluid and the natural blinking mechanism that disperses fluid over the eye area, causing eye dryness.

Additionally, eye injury increases the risk for infection and inflammation, which can also result in dryness. A preservative-free lubricating eye drop can be used to help manage dry eyes and relieve discomfort.

Wound care and COVID-19

Wounds Australia reveals the COVID-19 virus pandemic has led to unprecedented reports of device‑related pressure injuries in patients and health care workers.

The pressure injuries relate to the wearing of personal protective equipment (masks and goggles) amongst healthcare workers and facial pressure injuries in COVID-19 affected patients, as a complication of wearing ventilators to manage respiratory failure.

While there are myriad factors that come into play during the formation of pressure wounds, healthcare workers can address the extrinsic components such as pressure, shearing forces, friction and moisture.

Action that can help prevent pressure wounds includes reducing potential friction and shearing forces through proper positioning of PPE and devices, regular pressure relief, as well as optimal skincare practices to reduce moisture.

According to the National Pressure Injury Advisory Panel, the following skin management strategies may help reduce the risk of pressure injuries when using PPE face masks;

Prep your skin

  • Use a pH balanced cleanser.
  • Apply liquid skin sealants or protectants on areas of the skin that come into direct contact with a mask and allow skin to dry.
  • Do not use petroleum jelly or mineral oil as a skin sealant.

Reduce the pressure

  • Remove the mask by lifting the sides for at least 5 minutes every 2 hours and ideally 15 minutes every 2 hours.
  • If this isn’t practical, any pressure relief is helpful.

Stay safe

  • Don’t use dressings that alter the seal of the face mask.
  • If using prophylactic dressings on your nose or cheeks, recheck the seal of the mask.
  • When removing the thin prophylactic dressing, close eyes and avoid inhaling any aerosolized virus or particles.

Help wounds heal

  • Treat abrasions from masks with moisturiser, skin sealant, cyanoacrylate or a thin dressing.
  • Do not apply cyanoacrylates near the eyes or mouth.

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