Recommendations of community pharmacists for the treatment of sprains and strains


School of Pharmacy, PO Box 913, Dunedin, New Zealand. E-mail:


Objective To determine the recommendations that community pharmacists make when treating ankle sprains and strains, in particular regarding the use of non-steroidal anti-inflammatory drugs (NSAIDs). The current debate about this issue is whether to initiate NSAIDs immediately post-injury, or withhold for the first 48 hours to allow inflammation to occur. The opposing viewpoints are that ‘inflammation is a barrier to healing’ and that ‘inflammation is vital for healing’

Method In August 2005, a structured questionnaire was mailed to 493 community pharmacies throughout New Zealand and addressed to the pharmacist. Questions covered the advice and interventions (both pharmacological and non-pharmacological) that would be given to a patient presenting with a strain or sprain, beliefs about different analgesics and their role in treatment, and information relating to their postgraduate qualifications and prevalence of sprains and strain seen in their pharmacy.

Key findings The response rate was 46.5% (229), the mean number of sprains reported in a month was nine. Ninety-six per cent (219) of pharmacists recommended RICE (rest, ice, compression, elevation) as the mainstay of treatment in these types of injuries, and analgesics were recommended frequently, 89% (201). Almost half, 46% (104) of the pharmacists thought that NSAIDs should be withheld for 24–48 h post-injury, and almost half, 46% (104) did not; the remainder, 8% (17) were unsure.

Conclusion Current evidence is moving away from using NSAIDs immediately post-injury to treat strains and sprains. While many pharmacists are aware of this, there are still others who are either unaware of this new research or who disagree. Most pharmacists were treating these injuries well, but pharmacists need to be aware of current recommendations to make sure that they follow ‘best practice’ and minimise further harm to their patients.