Why Minor Summer Injuries Can Quickly Become More Serious Without Proper Care

Introduction

Summer is the time of year when people spend far more time outdoors — relaxing, traveling, exercising, playing sports, and staying physically active. Unfortunately, it is also a season when injuries become more common. Increased physical activity raises the risk of both minor and more serious injuries.

Almost any part of the body can be injured, although muscles and the musculoskeletal system are affected most frequently. Limb injuries caused by slipping, falling, or bumping into objects are among the most common. Fortunately, most injuries are relatively minor, including bruises, contusions, and muscle, tendon, or ligament strains, which can usually be treated conservatively.

The body’s primary response to tissue damage is activation of inflammatory pathways. After an injury, blood vessels release inflammatory mediators such as prostaglandins and neuropeptides, which contribute to pain development. Swelling occurs because blood vessels dilate and become more permeable after injury. Even minor trauma can trigger a localized inflammatory reaction, swelling, pain, and temporary impairment of the affected area.

In 2016, hospitals and emergency departments treated 314,025 outpatient injury cases (1). The majority involved shoulder and arm injuries (30.4% of outpatient trauma cases), followed by hip and leg injuries (27.9%) and head injuries (19.2%). Falls remain the leading cause of injury (1).

Most Common Injuries

Physically active people are not only at high risk for joint injuries but also for tendon and ligament damage. One of the most common injuries involves strained calf or knee tendons, where the joint itself is not dislocated and no fractures occur. Symptoms typically include pain, localized swelling, and restricted movement.

Tendon strains are common during sports and active leisure activities. Calf strain, in particular, is a frequent musculoskeletal injury. Symptoms may range from mild swelling and bruising to severe pain, hematoma formation, and impaired function.

Muscle strain is usually caused by sudden overstretching or forceful contraction. Muscles are commonly strained while walking, running, jumping, or making sudden directional changes. Pain, muscle spasms, and weakness often occur together.

Tendons and ligaments surrounding the ankle, knee, wrist, or finger joints may also become strained. If a tendon ruptures, a visible lump formed by the contracted muscle can sometimes appear beneath the skin.

Another common type of injury is joint dislocation or subluxation caused by slipping, falling, climbing, or similar accidents. A dislocation occurs when one joint surface completely slips away from another, while a subluxation occurs when the joint surfaces partially separate and the capsule and ligaments are stretched but not fully displaced.

The shoulder joint is the most common site of dislocation in adults, while elbow dislocation is more common in children. Dislocations typically cause visible joint deformity, severe pain, restricted movement, and localized swelling. Because dislocations are often accompanied by fractures, X-rays are recommended whenever fractures are suspected.

If a joint dislocates or subluxates, the injured person should be taken to a medical facility. Attempting to reposition a dislocated limb without medical assistance may worsen the injury.

Assistance For Minor Injuries

Treating soft tissue injuries promptly helps reduce inflammation, swelling, pain, and loss of function.

First aid for minor injuries generally follows the RICE principle:

• R – Rest: A few days of reduced activity may help prevent further damage.
• I – Ice: Cooling the injured area reduces swelling and relieves pain.
• C – Compression: Compression helps minimize swelling.
• E – Elevation: Raising the injured limb helps decrease swelling and discomfort.

In many cases, pain and inflammation also require medication.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to treat musculoskeletal conditions because of their anti-inflammatory and pain-relieving properties. These medications are commonly prescribed for both trauma-related injuries and chronic conditions in which pain and inflammation are dominant symptoms.

NSAIDs act on the underlying inflammatory process by reducing tissue swelling, inflammation, and nociceptive pain, helping prevent pain from becoming chronic. Oral NSAIDs are often used for acute and chronic pain relief, although they may cause systemic side effects.

Topical NSAIDs can also relieve pain but are less likely to cause systemic adverse effects because the medication remains concentrated locally rather than reaching high levels throughout the body (2–4). One of the most commonly prescribed NSAIDs for pain and inflammation relief is diclofenac.

Effectiveness Of Topical Diclofenac

Diclofenac has been used for many years to treat pain and inflammation (5) and remains one of the most extensively studied NSAIDs.

When applied locally, diclofenac reduces inflammation by inhibiting cyclooxygenase enzymes and suppressing inflammatory prostaglandin production. Its pain-relieving mechanism is less clearly understood, although research suggests diclofenac may act as a sodium channel blocker, producing a local analgesic effect through nociceptive nerve fibers (6). Additional studies indicate that diclofenac may also inhibit L-type calcium channels involved in pain perception (7).

Diclofenac is effective for relieving localized pain caused by acute tendon, ligament, joint, or muscle strains, bruises, and joint stiffness. Topical NSAIDs are particularly useful when the injury is located close to the skin surface, providing effective treatment directly at the site of injury while reducing the risk of digestive and cardiovascular complications associated with oral NSAIDs.

Diclofenac is absorbed slowly and incompletely through the skin. Continuous absorption helps maintain a stable concentration in blood plasma. Researchers also speculate that diclofenac may accumulate within the skin in a reservoir-like form before being gradually released and distributed throughout the body.

One scientific study compared topical diclofenac gel with ketoprofen patches for relieving pain caused by sports-related soft tissue injuries. The study included patients aged 18 to 70 who had experienced trauma within the previous 48 hours and reported significant pain both at rest and during movement.

The study involved 180 patients: 47 with tendon strains, 60 with muscle strains, 84 with bruises, and the remainder with mixed injuries. Researchers concluded that ketoprofen patches were not superior to diclofenac gel for pain reduction (8).

Another study involving 384 patients with acute soft tissue injuries found that diclofenac gel was more effective than felbinac gel, another NSAID treatment, in reducing pain at rest, during movement, and during palpation. Diclofenac also showed greater effectiveness in reducing swelling, improving mobility, and decreasing the need for additional pain medication (9).

A broader review of 19 studies involving approximately 3,000 patients with osteoarthritis or soft tissue injuries evaluated the effectiveness of topical diclofenac in pain reduction (10). Researchers found that topical diclofenac reduced pain intensity and inflammation in both chronic and acute conditions compared with oral diclofenac and other NSAIDs such as ibuprofen and naproxen. It also improved joint mobility and function.

Topically applied diclofenac was superior to placebo and generally caused fewer adverse reactions than oral NSAIDs. One possible side effect of topical diclofenac is mild local skin irritation at the application site (10).

Summary

Minor injuries are a common part of everyday life, particularly during warmer months when people tend to be more physically active. After a minor injury, rest, cooling, compression, and elevation are recommended to reduce soft tissue swelling and pain.

NSAIDs such as diclofenac gel are frequently prescribed to relieve inflammation and discomfort. Topically applied diclofenac penetrates the skin and reaches effective concentrations within inflamed joints, muscle tissue, and synovial fluid.

Current evidence suggests that topical diclofenac is an effective and generally safe option for relieving localized pain caused by acute tendon, ligament, joint, or muscle strains, bruises, and joint stiffness.

Publication “Internistas” No. 6, 2018.

REFERENCES 1.    Health Information Center of the Institute of Hygiene. Injuries and Poisonings in Lithuania 2016. Vilnius 2017. Available online: http://www.hi.lt/uploads/pdf/leidiniai/Statistikos/Traumos/Traumos2016.pdf 2.    Heyneman CA, Lawless-Liday C, Wall GC. Oral versus topical NSAIDs in rheumatic diseases: a comparison. Drugs. 2000;60: 555-574. 3.    Haroutiunian S, Drennan DA, Lipman AG. Topical NSAID therapy for musculoskeletal pain. Pain Med. 2010;11:535-549. 4.    Ribeiro MD, Joel SP, Zeppetella G. The bioavailability of morphine applied topically to cutaneous ulcers. J Pain Symptom Manage. 2004;27(5):434-439. 5.    Zacher J, Altman R, Bellamy N, et al. Topical diclofenac and its role in pain and inflammation: an evidence-based review. Curr Med Res Opin 2008;24(4):925-50. PM:18279583 6.    Chen X, Gallar J, Belmonte C. Reduction by antiinflammatory drugs of the response of corneal sensory nerve fibers to chemical irritation. Invest. Ophthalmol. Vis. Sci. 1997, 38, 1944–1953. 7.    Yarishkin OV, Hwang EM, Kim D, et al.  Diclofenac, a non-steroidal anti-inflammatory drug, inhibits L-type Ca channels in neonatal rat ventricular cardiomyocytes. Korean J. Physiol. Pharmacol. 2009;13(6), 437–442 8.    Esparza F, Cobian C, Jimenez JF, Garcia-Cota JJ, Sanchez C, Maestro A. Topical ketoprofen TDS patch versus diclofenac gel: efficacy and tolerability in benign sport related soft-tissue injuries. Br J Sports Med 2007;41(3):134-9. PM:17138642 9.    Bouchier-Hayes TA, Rotman H, Darekar BS. Comparison of the efficacy and tolerability of diclofenac gel (Voltarol Emulgel) and felbinac gel (Traxam) in the treatment of soft tissue injuries. Br J Clin Pract. 1990;44(8):319-320. 10.    Zacher J, Altman R., Bellamy N, et al. Topical diclofenac and its role in pain and inflammation: an evidence-based review. Current Medical Research and Opinion, 2008;24:925-950.