Many of us are not sure what to do when an ankle is twisted or a muscle is pulled. Here is some information about these basic types of injuries and suggestions regarding first aid and rehabilitation.

Sprains

A sprain is an injury to a joint ligament. Ligaments are the strong bands of tissue that connect one bone to another at a joint. The severity of the injury can be classified by the amount of tissue tearing, joint stability, pain, and swelling.

• A first-degree sprain (the mildest) has little tearing, pain, or swelling, and joint stability is good.
• The second-degree sprain has the broadest range of damage, with moderate instability and moderate to severe pain and swelling.
• The most serious sprain is a third-degree sprain. The ligament is completely ruptured and the joint is unstable. There may be severe pain at first, but afterwards there may be no pain. There will be a lot of swelling with this type of sprain, and often other tissues are damaged.

Strains 

A strain is damage to muscle fibers and to the fibers that attach the muscle to the bone. Other names for a strain include torn muscle, muscle pulls, and ruptured tendon. Muscle injuries are also classified in degrees. 

• A first-degree strain (the least severe) has little tissue tearing, mild tenderness, and pain with full range of motion.
• The second-degree strain has a wide variability. Muscle or tendon tissues have been torn, resulting in very painful, limited motion. There may be some observable swelling or a depression at the spot of the injury.
• The third-degree strain involves complete rupture of a part of the muscle unit. Motion will be severely decreased or absent. Pain will be severe at first, but the muscle may be painless after the initial injury. 

Treatment

Management of both sprains and strains follows the "PRICE" principle.

P - Protect from further injury.

R - Restrict activity.

I - Apply ice.

C - Apply compression.

E - Elevate the injured area.

This principle limits the amount of swelling at the injury and improves the healing process. Splints, pads, and crutches will protect a joint or muscle from further injury when appropriately used (usually for more severe sprains or strains). Activity restriction (usually for 48 to 72 hours) will allow the healing process to begin. During the activity restriction, gentle movement of the muscle or joint should be started. Ice should be applied for 15 to 20 minutes every hour to hour and a half. Compression, such as an elastic bandage, should be kept on between icing; you may want to remove the bandage while sleeping, though keeping it compressed even during the night is best. Elevating the limb will also keep the swelling to a minimum.

If you suspect more than a mild injury, cannot put weight on the limb, or it gives way, you should consult with a health care provider.

Exercising is great for the body, but it is important to take proper care of yourself during and after your workout. Depending upon the length of your workout or competition, performance and endurance can be primarily limited by three factors:

• Loss of body fluids. Research has shown that losing more than 2 percent of your weight as sweat during prolonged exercise or sports activities can hamper performance.
• Drop in the levels of blood sugar. The brain uses a steady supply of sugar in the blood (blood glucose) for fuel. During exercise or sports performance, glucose levels in the blood are drained. This can produce a lightheaded, sometimes woozy feeling.
• Depletion of muscle carbohydrate stores. During exercise, muscles use stored carbohydrate (glycogen) as fuel. Depending upon the intensity and duration of your workout or sports participation, your muscles can also lose carbohydrate. 

Sports Drinks

Mixtures of water and carbohydrate, sports drinks make an excellent fueling and hydration choice. Years of research clearly show that for exercise lasting anywhere from 60 minutes to several hours, drinking these carbohydrate beverages significantly boosts endurance performance compared with drinking plain water. Some research even suggests that you can expect an improvement in endurance of about 20 percent or more in workouts lasting over 90 minutes.
     Most sports drinks offer a blend of carbohydrate sources such as the sugars sucrose, glucose, fructose, and galactose.A few beverages may also add maltodextrin, a complex carbohydrate made of several glucose units. Some research suggests that sports drinks offering a blend of carbohydrates such as glucose and sucrose, rather than a single carbohydrate source, may improve the amount of carbohydrate that eventually gets to the muscles as fuel. By offering the intestinal tract different sugars, the rate of carbohydrate absorption isimproved, since different sugars are absorbed by different routes. This means more "carbs" make it to the muscles as fuel for exercise or sports performance.
     Sports drinks also come with added electrolytes. Sodium, the electrolyte lost in the greatest amount via sweat, helps maintain fluid balance in the body. It also promotes the uptake of fluid in the intestines and improves hydration.
     Most commercial sports drinks supply a blend of sugars at the right amount: 4 percent to 9 percent solution, or about 13 to 19 grams of carbs per 8 ounces. Drinking 1 1/2 to 4 cups per hour (more if you have heavy sweat losses) will provide you with both the fluid and carbs you need for endurance. Choose a beverage flavor you enjoy, as this may encourage you to drink more. "Fitness waters," while tasty, do not provide enough carbohydrates to boost endurance, but certainly can keep you hydrated. Drinking prior to and after exercise are also important factors in maintaining proper hydration levels.

Carbohydrate Gels

Pudding-like in texture, carbohydrate gels come in small, single-serve packets much like a sample of shampoo, making them portable fuel that you can easily put in your waistband pocket. Simply tear off the packet top at the perforation and squeeze the gel into your mouth - easily done on the run. Gels consist of sugars and maltodextrins (the same as sports drinks but without the water), which are easily digested. Many gels come with added electrolytes that, as with sports drinks, help maintain fluid balance. Some gels also have added extras such as ginseng and other herbs, amino acids, vitamins, and Co-enzyme-Q10 (a nonessential substance found in the body). Research does not support that these ingredients have any performance benefit, but they probably are present in amounts that are too small to present any risk. Some gels also contain caffeine in varying amounts. Check the label and consult the manufacturer's website for specific content, as some gels have as much caffeine as a half cup of coffee, which may cause nervousness in those not accustomed to this stimulant.
     Most carb gel packs contain 100 calories or 25 grams of carbohydrate. Try to consume one to three packets for every hour of exercise, depending on the intensity and duration. Since gels come in a variety of flavors, from vanilla and chocolate to strawberry and cherry, find a couple you enjoy and remember to swallow them down with about 4 to 8 ounces of water.

Energy Bars

Many types of energy bars are now available. From high-protein bars to those that are marketed specifically for women, the energy bar scene is anything but simple. Some label reading is a must when it comes to choosing the right bar for fueling. High-carbohydrate bars make great choices for carbohydrate fueling both before and during a long workout. These bars typically provide about 70 percent of their calories from carbohydrate as sugars (brown rice syrup and sucrose) and grains (oats and rice crisps). How quickly these carbohydrates get into the circulation is referred to as the glycemic index. Eating a high-glycemic-index bar means rapid release of carbohydrate into the blood stream, giving the muscles a quick "shot" of fuel, which is ideal during a workout. Eating a low-glycemic-index bar results in a slower release of sugar into the circulation and thus sustained energy, which is best before exercise. Many bar manufacturers claim that their profile of carbohydrate sources (such as oats and other complex carbohydrates) are best for a sustained and lasting fitness session.