Acute Injury Management

I often get asked 'what's the best way to manage an injury in the early stage?' Here are my thoughts based on anecdotal and researched evidence.

 

Summary…

By adhering to the components of ‘POLICE’ for the first 2-5 days

following injury you can optimise the healing process from the

very start. Read on for further details on how best to apply each

component.

 

How injuries occur….

Typically, injuries occur when the capacity of a given tissue,

commonly muscle, tendon, ligament, or cartilage is exceeded.

This can occur suddenly and involve trauma such as spraining

ankle or knee ligaments during a fall or straining a muscle whilst

performing a high velocity action such as sprinting. These injuries

normally result in acute localised pain forcing cessation of the

given activity. Tissues can also succumb to repeated low grade

forces, often taking time (days, weeks or even months) to become

symptomatic such as a runner suffering a niggling Achilles tendon.

Often injuries of this manner allow activity to continue and may even feel better during bouts of exercise, but become increasingly painful post activity, perhaps later that evening or the following morning.

Recovery times hinge largely on the severity and type of tissue injured but are also heavily influenced by the rehabilitation and management strategies employed in the early, middle and late stage of recovery.

 

What you can do….

Regardless of the factors surrounding the onset of a soft tissue injury, immediate management can substantially influence recovery, owing to the well-known acronym of R.I.C.E, standing for ‘rest, ice, compress, elevate’.  This did evolve some years ago to PRICE which included ‘protect’, and has evolved further still with recent evidence (Bleakley et al, 2011) advocating ‘rest’ be replaced with ‘optimal loading’ (POLICE).

These interventions seek to act on the local inflammation that occurs around the injury site, synonymous with the swelling, bruising and pain we often experience. This inflammation, although vital for recovery, is thought to occur excessively around the injury site and thus can slow down the journey back to full health (Ogilvie-Harris & Gilbart 1995).

 

The specifics….

 

PROTECTION – preventing further damage to injured soft tissues is imperative in the early hours following trauma, to maximise healing, however prolonged unloading will have the opposite effect.

Our advice: ‘The degree of protection required can vary from simply reducing sporting activity for a short while to complete rest with the aid of crutches or a sling and will depend on the injury sustained.

 

OPTIMAL LOAD - early mechanotherapy following a short period of protection has been shown to improve recovery more rapidly in many scenarios by encouraging improved adaptation in the tissue. This can include massage, mobilisation and most importantly therapeutic and progressive exercise.

Our advice: ‘Typical sprains and strains can respond well to early light flushing massage. Contusion or corked injuries such as knocks or dead legs conversely, are better treated with sustained stretching during this phase. Facilitating natural movement and working on accessory muscles/tendons also plays a vital part of early optimal loading and should not be neglected’  

 

ICE – Initially advocated as a means to reduce excess swelling through reducing cell metabolism and causing vasoconstriction (narrowing of blood vessels), this has been questioned with regards to its effectiveness of achieving this (as warm blooded animals remain fairly warm in the subdermal tissues!)

Research does agree that it can be a very useful analgesic, lessening pain in this early phase, and therefore icing continues to form part of early soft tissue injury management throughout elite sport.

Our advice: ‘approximately 20mins of application every hour as practically possible, with a wet barrier (damp cloth), is a sensible stance for this although there is little evidence of longer or shorter applications. Be sure to check the area regularly throughout application for evidence of ice burns (soreness/blistering and remove if any concerns)’

 

COMPRESSION – by applying external pressure to the injured area through a compression bandage or compressive clothing the spread of inflammation to neighbouring healthy tissues is reduced.

Our advice: ‘Tubigrip tends to work well for smaller joints and muscles but should only be applied throughout the waking day unless advised otherwise. Myofascial or compressive taping can also be helpful’

 

ELEVATION – decreasing the influence of gravity on internal fluid movement reduces the degree and spread of swelling. 

Our advice: ‘This can be achieved by elevating the injured limb in relation to the level of the heart when practically possible to do so. This can be as simple as resting the injured leg on a foot stool when sitting, or propped up on extra pillows at night’

 

Other factors promoting recovery:

·         Increased sleep (8hours plus per night)

·         Reduced alcohol intake

·         Increased dietary protein

·         Contralateral (opposite/non injured) limb training.

 

Employ these strategies to kick start your recovery.

 

*N.B Although the above advice is considered conservative and safe, precautions should be taken depending on your health/medical history, please consult a healthcare professional for further advice if you are at all uncertain.

 

References

Bleakley, C.M., Glasgow, P., MacAuley, D.C., PRICE needs updating, should we call the POLICE? British Journal of Sports Medicine, 2011 Vol 46, Iss 4

Ogilvie-Harris, D.J., Gilbert, M. Treatment modalities for soft tissue injuries of the ankle: a critical review. Clinical Journal of Sports Medicine. 1995, 5(3) 175-186. a

Acute Injury Management with 'POLICE'

Protect

Optimal-

Loading

Ice

Compression

Elevation