Acute Injury Management

February 23, 2020

Soft tissue injuries (ie injuries to muscles, tendons, ligaments, nerves etc – all the ‘soft stuff’) are, unfortunately, very common and can happen to the best of us. While injuries can occur during sporting events, training sessions or other recreational activities, they often occur when you least expect them. No matter how fit or prepared we are, sometimes there is just no avoiding that tackle, that other car, or that wobbly bit of curb (not to mention the high heels we probably could have avoided but made us look so graceful…until we stacked it in the middle of the dance floor).

In the early, or acute, stage of a soft tissue (ie the first 48-72 hours), the body’s own protection system very cleverly sends inflammation to the area of injury, usually experienced as pain, swelling, redness and loss of function. Inflammation is a normal part of healing, and is useful in these early days, however, excessive or prolonged inflammation can result in higher pain levels, reduced function and a prolonged recovery. Acute injury management is, therefore, directed at minimising (not removing!) inflammation.

Various acronyms have been created and used over the years to help people manage their soft tissue injuries within this acute stage. The first of these, which most of us have heard of, was ‘RICE’ – Rest, Ice, Compression, Elevation. This was then changed to ‘PRICE’ – Protection, Rest, Ice, Compression, Elevation. However, as our knowledge and understanding of injuries and their healing processes developed, we discovered that too much ‘Rest’ could actually prolong, or even prevent, successful recovery. And so, we come to the most up to date acronym…

POLICE – Protection, Optimal Loading, Ice, Compression, Elevation

Acute Injury – Call the P.O.L.I.C.E!!

So what do we really mean by each of these words?

 Protection during the first few days after a soft tissue injury is required to minimise further damage. Temporarily adjusting your activity levels will help exposing the area to further injury. If it is a lower limb injury the use of crutches may be necessary to help you to walk. After a few days, gentle motion can be started to aid the healing process.

Optimal Loading, or ‘progressive mechanical loading’ should begin as soon as possible as it is vital in the restoration of strength, mobility and function in the joint, whilst also aiding recovery and promoting optimal healing. Your pain levels should guide you while you gradually put more pressure through the injured tissue, however, if pain levels are too severe, consider the use of over the counter paracetamol or ibuprofen to allow you to get moving, or speak to a GP or pharmacist to discuss stronger options.

Ice, when applied within the acute phase of injury, is used to reduce inflammation and pain which, in turn, will help you practice more ‘optimal loading’. Apply ice for 15 – 20 minutes every couple of hours and always protect your skin with a light towel to prevent any ice burns. A few things to consider before you pop that ice on though….

1. Don’t apply ice over an open wound.
2. Don’t apply ice over skin in poor condition or if you have poor circulation.
3. Use extra care if you suffer from diabetes as altered sensation may increase your risk of an ice burn.
4. If you experience any skin irritation or increase in pain or swelling stop applying the ice.

Compression & Elevation help to reduce swelling through pressure (by reducing the amount of space that the injured tissue can swell into), or gravity (elevating the injured joint above the level of the heart which helps with drainage of any swelling). Reducing the swelling will help you to make a quicker recovery by reducing pain and swelling and improving the blood flow to the area. Compression can be achieved with a light strapping or elastic bandage such as tubigrip (other makes of elastic bandage are available!). When using some form of compression, however, do make sure it is not too tight as this could limit blood flow to the affected area.

At the end of the day, the body’s tissues are amazingly resilient and even once injured are difficult to injure further. The body’s own healing processes are designed to get us up and running again as fast as possible, sometimes it just needs a little help, but if you follow the guidance above followed by a good rehab program with a physiotherapist, you will be up, running, or even hurdling in no time.