“It’s Just a Twist… Or Is It?”

Posted on 1st August 2025 at 14:14

Managing Sprains and Strains in the Outdoors

Written from the perspective of an EMT

You’re halfway through a group walk when someone missteps on a loose rock. They go down hard, and you hear those classic words:

“I think I’ve just twisted it. I’ll walk it off.”

As an EMT, I’ve learned never to underestimate soft tissue injuries. Out here, even a “minor sprain” can turn into a major problem if not managed properly.

Teaching management of sprain on hillside.

🦴 What is a Sprain? What is a Strain?

Sprain = Ligament injury

Happens when a joint (like an ankle or knee) is twisted or forced beyond its range

Ligaments get stretched, torn, or even ruptured

Strain = Muscle or tendon injury

Usually caused by overstretching or overuse

Think of it like a pulled muscle

Key signs (of both):

Sudden pain at the time of injury

Swelling, bruising, tenderness

Reduced movement

Pain when bearing weight (sprain) or when activating a muscle (strain)

Sometimes a popping sound at the time of injury

🏞️ What to Do in the Field

If you’re hours from help, good early management makes all the difference.

Step 1: Stop the activity

Don’t “walk it off” — it can worsen damage

Get the person to rest and assess the injury

Step 2: Think “RICE” (or PRICE)

P – Protect from further injury (immobilise the limb if needed)

R – Rest – Avoid weight bearing or further movement

I – Ice – Apply cold (ice pack or wet bandana dipped in stream) for 15-20 mins

C – Compression – Light bandaging can help reduce swelling

E – Elevate – Raise the limb if practical (above heart level if possible)

💡 No ice? Use a cold bottle of water, a wet cloth, glove with damp soil or stream-cooled bandage

Step 3: Pain relief

Paracetamol (if appropriate and they consent)

Never give anything they’ve not taken before unless they’re sure

Step 4: Monitor and Plan

Can they bear weight after rest? Walk 10 steps without sharp pain?

Is the joint stable, or does it “give way”?

Any signs of deformity, numbness, or severe swelling? These could indicate a fracture or dislocation

If you suspect a fracture, joint instability, or the pain is worsening fast → time to evacuate.

🔁 Strain or Break?

Here’s a tip:

If they can’t move it without pain or the limb looks out of shape → treat it like a break until proven otherwise. Better safe than sorry, especially miles from help.

🛠️ Improvised Kit Tips

Bandana or buff for compression

Trekking pole or foam mat for splinting

Tape or triangular bandage for ankle support

Rucksack foam back or SAM splint if carrying a first aid kit

🥾 So, do you take the boot off? The answer: It depends

✅ When to Take the Boot Off

You suspect a significant injury (e.g. moderate-to-severe sprain, possible fracture, dislocation)

There’s increasing pain, swelling, or numbness

The casualty won’t be walking out

You’re more than 30 minutes from help

You need to properly assess, support, or splint the limb

Once swelling sets in, removing the boot can become very difficult or impossible, cutting off circulation.

Better to remove early if in doubt, assess, and manage.

⚠️ When You Might Leave It On

It's a minor twist, they can weight-bear and walk (with help)

You’re within a reasonable distance of professional medical care

The casualty insists on walking out and seems stable

You suspect only soft tissue bruising, not instability

That said, even in these cases, it’s worth loosening laces to reduce constriction.

🚨 But if you leave it on… monitor closely.

Mark where toes are for comparison

Regularly check for:

Circulation (pink, warm, capillary refill <2s)

Sensation (can they feel toes?)

Movement (wiggle toes?)

If signs of compromised circulation or swelling → get it off carefully

💡 Pro tip from the trail:

Always have a pair of scissors or trauma shears handy

Laces, socks, and tight-fitting boots can become a real problem if swelling worsens

Cut down the side of the boot or slice laces if needed

Summary:

🥾 Take the boot off if you're uncertain.

Better to remove it early while you can, assess and support the injury, than risk swelling that leads to tissue damage or inability to remove the boot later.

🏕️ Final Thoughts

Sprains and strains may not seem like much, but out here, they stop journeys, delay rescues, and challenge group safety. Treat them seriously from the start, and you give your casualty the best shot at recovery — without calling a helicopter.

Want to build real-life injury management skills?

Join one of our outdoor or wilderness first aid courses (free or paid) — hands-on, realistic, and tailored to what you actually face out there.