Increasingly the first port of call for people with sports injuries, pharmacy teams need to keep up to date with the latest advice, and be alert to any ‘red flags’, reports Kathy Oxtoby...

Easily accessible, community pharmacy is increasingly the first port of call for first aid and sports injuries. But pharmacists need to ensure their team’s – and their own – first aid training is up to date.

“We may be consulted by patients with emergency situations, so we need to be adequately trained in first aid to support them,” says Lila Thakerar, superintendent pharmacist at Shaftesbury Pharmacy in Harrow. Pharmacists also need first aid training to support their workforce. And regular training – around every three years – is needed to keep up to speed with the latest guidance, she says.

Head injuries

Ade Williams, lead pharmacist at Bedminster Pharmacy in Bristol, says that when a patient presents with a head injury, it’s important to take a history, and to ask them if they have recently taken part in sport. Minor head injuries such as bumps and bruises are common and not usually serious. However, patients with concerns are advised to see their GP .¹ Pharmacists and pharmacy team members should also be alert to any ‘red flag’ symptoms a patient may be experiencing after a head injury. Typically, symptoms will appear within 24 hours, says Ms Thakerar. Red flag symptoms include drowsiness, difficulty speaking, unconsciousness (even briefly), significantly blurred or double vision, and vomiting,¹ severe ¹ headache, fluid leaking from the nose, or bleeding from the ears. Patients should be advised to go to A&E or call 999 for an ambulance if any of the symptoms of a severe head injury develop.¹

Chest pain

When a patient presents with chest pain, Ms Thakerar advises looking out for symptoms such as a sudden, crushing pain that radiates into the jaw or the left arm. “These are red flags and the patient should immediately go to A&E,” she says. Symptoms that could indicate cardiac problems can be subtle – and this includes indigestion, “so you need to question patients about their previous symptoms,” advises Lindsey Fairbrother, owner and superintendent pharmacist at Goodlife Pharmacy in Hatton, Derbyshire. “Chest pains need investigating,” she says. “Don’t take any risks.”

Neck injuries

Patients with neck injuries can present with stiffness or pain radiating from the neck, says Ms Thakerar. Pharmacists are advised to carry out an initial assessment and if there are any issues with breathing or a loss of sensation, such as in the fingers and arms then the patient should be referred. If the neck injury is “wear and tear” from say, playing sport, and there are no concerning signs, such as head injury, it can be helped with anti-inflammatory tablets and rubs, ice therapy for acute pain, followed later by heat therapy, says Ms Fairbrother. She recommends referring patients to a physiotherapist if their symptoms do not ease.

Bone injuries

Repetitive activity or a heavy impact while playing sport can injure bones, causing stress fractures, shin splints, a broken ankle, arm, wrist, leg, finger or toe.¹ A broken bone may cause swelling, significant bruising and tenderness around the injured area, and bleeding if the bone has broken the skin – an open fracture.

Pain associated with a broken bone can be severe and make patients feel faint, dizzy and sick.¹ If any part of the body looks deformed, including the fingers, the patient may have broken a bone and should be referred to A&E for further investigation.¹ Pharmacists can also offer patients pain relief until they get their bone injury checked, says Ms Thakerar. First aid for sprains – when to use ice or heat Sprains are the most common type of sports injury, and happen when muscle tissues or fibres are stretched or torn ¹ Symptoms can include pain, swelling, bruising and tenderness around a joint or in a muscle, and the patient may also find it difficult to move the affected body part. Sprains are most common in wrists, ankles, thumbs and knees ^1.

For the first three days, ice should be used to reduce swelling, advises Ms Thakerar. After this, heat should be applied “to increase the blood supply and help with the healing process”, she says.

When does a patient need a knee brace?

The purpose of a knee brace is to stop the knee being overused after an injury, and it supports the knee, says Ms Thakerar. “Generally, a knee brace will be prescribed and should always be provided under guidance and supervision,” she says.

First aid for knee pain and injury

Sudden knee pain is common in contact sports, especially those that involve twisting, and is usually caused by a sprain, strain, or tendonitis .¹ Being overweight can increase the risk of knee problems. “Obesity can cause knee pain, and pharmacists can signpost patients to weight management advice,” says Ms Thakerar.

She adds that a lack of flexibility, and previous injuries can also make the knee more tender, painful, and sometimes lead to inflammation. “All these issues need to be considered when recommending any relief or support around the knee,” she says. RICE therapy can help bring down swelling and support the injury.² The four steps involve:

• Rest – stop any exercise or activities and try not to put any weight on the injury

• Ice – apply an ice pack (or a bag of frozen vegetables wrapped in a tea towel) to the injury for up to 20 minutes every two to three hours

• Compression – wrap a bandage around the injury to support

• Elevate – keep it raised on a pillow as much as possible. ²

Heat treatment can be used after a few days, and supports and splints can help to prevent any further movement around the injured area, says Ms Thakerar. Pharmacists are also well placed to help prevent knee pain, such as by suggesting dietary advice and weight bearing exercises, says Mr Williams.

Sports injuries

Senior brand manager for Deep Heat and Deep Freeze Elaine Walker says that “given the trend to step away from oral painkillers, topical products are key”. “In addition,” she adds, “most muscle and joint pain can be pinpointed, so patients want targeted relief, such as gels and patches that they can apply directly at the point of pain and reapply when needed.” She says sports injuries “require different treatment, depending on the injury and when it occurred” and that means providing topical treatments “offering cooling or heating therapy” in various formats, such as gels, patches, rubs, creams and sprays.

Shortness of breath

Shortness of breath can have many different causes, including asthma, chest infection, being overweight, smoking, and a panic attack. Sometimes, shortness of breath could be a sign of chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis, heart failure, or lung cancer. ³

Mr Williams says it’s important to take a history and to refer the patient if there are any concerns. If the concerns are smoking related, pharmacists can “consider giving smoking cessation advice”, he says. While pharmacy should be encouraging people to keep active, it is also important that they exercise safely, says Ms Fairbrother. And she says pharmacists should be “alert to the more serious consequences of sport and know when to refer patients with sports injuries.”

References 

1. NHS 111 Wales (2022) Sports injuries. https://111.wales.nhs.uk/encyclopaedia/s/article/sportsinjuries
2. NHS 111 Wales (2022) Sprains and strains. https://111.wales.nhs.uk/encyclopaedia/s/article/sprainsandstrains
3. NHS 111 Wales (2020) Shortness of breath. https://www.nhs.uk/conditions/shortness-of-breath/