Injuries in the warm season: how can we help ourselves?

Introduction

Summer is the season when people spend significantly more time outdoors compared to other times of the year – relaxing, vacationing, being more active, exercising, playing active games, and going on outings. It is also a time when injuries are more common. Sports and increased physical activity increase the risk of both minor and more serious injuries. Injuries can affect any part of the body, but the muscles and skeletal system sustain the most damage. Slipping, falling, or bumping frequently causes limb injuries. Most injuries are minor, such as bruises, contusions, and muscle, tendon, or ligament strains, and can be treated easily with conservative measures.

The body's main response to tissue damage involves the activation of inflammatory cascades. After an injury, blood vessels release inflammatory mediators such as prostaglandins and neuropeptides, which promote the development of pain. Swelling occurs due to increased vasodilation and enhanced vascular permeability after an injury. Even minor injuries can trigger a local inflammatory reaction, causing swelling, pain, and temporary impairment of the affected area's function.

In 2016, hospitals and emergency departments treated 314,025 outpatient cases due to injuries (1). Most patients experienced shoulder and arm injuries (30.4% of all outpatient trauma cases), hip and leg injuries (27.9%), and head injuries (19.2%). Falls are the most common cause of injuries (1).

Most Common Injuries

Physically active individuals face a high risk of joint, tendon, and ligament injuries. Calf or knee tendon strains are the most common injuries, where the joint isn't dislocated, and there are no fractures. Symptoms of a strain include pain, localized swelling, and limited movement. Tendon strains frequently occur during any activity, including sports and active rest. Calf strain is a common musculoskeletal injury, with symptoms ranging from mild swelling and bruising to intense pain, hematoma, and impaired function.

A muscle strain results from excessive and sudden stretching or forceful contraction. Muscles are most often strained while walking, running, jumping, or making sudden changes in movement direction. Pain, muscle spasms, and muscle weakness may occur together. Tendons and ligaments around the ankle, knee, wrist, or finger joints can also be strained. If a tendon ruptures, a lump (contracted muscle) may form under the skin.

Joint dislocation and subluxation from slipping, falling, climbing, etc., are other types of injuries. A joint dislocates when one bone joint surface slips off another bone joint surface. When the bone joint surfaces don't completely separate, only the joint capsule and ligaments are stretched, resulting in subluxation. Dislocation occurs when a bone is displaced from its usual position. The shoulder joint is the most common dislocation site in adult patients, while in children, it is the elbow joint. Dislocation causes joint deformity, severe pain, restricted movement, and localized swelling. Dislocations are often accompanied by bone fractures, so an X-ray should be performed if fractures are suspected. When a joint dislocates or subluxates, it's important to bring the person to a medical facility. Attempting to relocate a dislocated limb without medical assistance can worsen the condition.

Assistance for Minor Injuries

Measures that treat soft tissue injuries help reduce inflammation, pain, and swelling, and restore function. First aid for a minor injury should follow the RICE rule. •    R – rest. For a minor injury causing functional impairment, a few days of rest may be sufficient to prevent further injury; •    I – ice. It reduces swelling and eases pain; •    C – compression. Helps reduce swelling; •    E – elevation. Reduces swelling and pain in the injured area.

Often, pain and inflammation require medication.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to treat musculoskeletal conditions due to their anti-inflammatory and pain-relieving properties. These drugs are used for trauma or chronic conditions where pain and inflammation are predominant. NSAIDs act on the pathogenesis and reduce tissue swelling, inflammation, and nociceptive pain, preventing pain from becoming chronic. Oral NSAIDs are commonly used to relieve acute or chronic pain, but they can cause systemic adverse reactions. Topical NSAIDs help alleviate pain but are less likely to cause systemic adverse reactions because the local drug concentration is clinically effective and does not increase systemically to a level that could lead to severe adverse reactions (2–4). One of the most commonly prescribed NSAIDs for pain and inflammation relief is diclofenac.

Effectiveness of Topical Diclofenac

Diclofenac has served as a remedy for pain and inflammation for many years (5). It stands as one of the most extensively studied NSAIDs. Locally applied diclofenac reduces inflammation by inhibiting cyclooxygenase enzymes and suppressing the synthesis of inflammatory prostaglandins. The mechanism behind its pain-relieving effect is not well understood. Research suggests that diclofenac can act as a sodium channel blocker, causing a local pain-relieving effect through nociceptive afferent fibers (6). Additionally, there is evidence that diclofenac can inhibit L-type calcium channels, which play a role in sensing pain (7).

Diclofenac effectively relieves local pain caused by acute tendon, ligament, joint, or muscle strain, bruising, or joint stiffness. Topical NSAIDs are administered when the injury is close to the skin surface. This treatment provides significant relief at the site of injury without leading to complications in the digestive and cardiovascular systems.

Diclofenac absorbs slowly and incompletely from the skin surface. Continuous absorption of diclofenac maintains a constant concentration in the blood plasma. When used externally, diclofenac is speculated to accumulate in the skin in a reservoir form, from where it slowly releases and distributes throughout the body.

A scientific study compared the effect of locally applied diclofenac gel with a ketoprofen patch in relieving pain caused by sports-related soft tissue injuries. The study included patients aged 18-70 who had experienced trauma in the past 48 hours and felt significant pain both at rest and during movement. The study involved 180 patients: 47 diagnosed with tendon strains, 60 with muscle strains, 84 with bruises, and the rest with mixed injuries. The authors concluded that ketoprofen patches were not superior to diclofenac gel in reducing pain (8).

Another study involving 384 patients who experienced acute soft tissue injuries found that diclofenac gel was more effective than felbinac (another NSAID) gel in assessing pain at rest, during movement or palpation, as well as in assessing swelling, mobility, and additional need for pain medication (9).

In 19 studies evaluating the effectiveness of locally applied diclofenac in reducing pain, 3,000 patients with osteoarthritis or soft tissue injuries participated (10). Locally applied diclofenac reduced pain intensity and inflammation in both chronic diseases and acute conditions compared to oral diclofenac and other NSAIDs (ibuprofen, naproxen), also improving joint mobility and function.

Locally applied diclofenac was superior to placebo. In terms of safety and drug tolerance, locally applied diclofenac caused fewer adverse reactions compared to oral forms of the drug and other oral NSAIDs. One of the possible reactions caused by locally applied diclofenac is mild local skin irritation at the site of application (10). Summary Minor injuries are a common occurrence in everyday life, especially in warmer months when people are more active. After experiencing a minor injury, rest, cold, local pressure, and elevation of the limb are recommended. This reduces soft tissue swelling and pain. NSAIDs, such as diclofenac gel, are often prescribed to relieve these symptoms and inflammation. Locally applied diclofenac penetrates the skin and creates an effective concentration in inflamed or injured joints, muscle tissues, and synovial fluid. It is an effective and safe drug for local pain relief caused by acute tendon, ligament, joint, or muscle strain, bruising, or joint stiffness.

Publication "Internistas" No. 6 2018.

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