What Should I Do With my Acute Injury?
So have you heard about R.I.C.E for injury management Rest Ice Compression Elevation? Well RICE has reached its 'Use By' date, and now when we are injured, we need the POLICE!
What is POLICE?
It is the most up to date first aid method of treating musculoskeletal injuries. In the past we were always taught to RICE (Rest, Ice, Compress, Elevate) and PRICE (Protection, Rest, Ice, Compress, Elevate). But now it is POLICE and here it was it stands for:
PROTECTION
This is super important to help avoid further tissue damage but it does not mean you have to immobilise the body part. Protecting it might mean using crutches if you have hurt a lower limb. Or if the injure is less severe, it may mean stopping running. It should be done in a way that allows an appropriate amount of rest in order for your injury to heal as well as it can.
OPTIMAL LOADING
This will stimulate the healing process. Bone, tendon, ligament and muscle all need some loading in order to stimulate the tissue to heal at cellular level.
The right amount of activity can help manage swelling. For instance, if you have an ankle sprain it can help to contract the calf muscles. This contraction will encourage swelling to move up the body against gravity. Complete rest/immobilisation would prevent this.
There are times when loading may not be necessary such as with a fracture that will require surgery [1]
ICE
Ice therapy (aka Cryotherapy) reduces tissue metabolism [2] and causes blood vessel constriction. This physiological change slows down and prevents further swelling or bleeding. Ice can also decrease the stimuli to the brain which can reduce pain and muscle spasm [3].
You do not want to apply ice to an injury for too long as it can result in skin burns and nerve damage due to blood flow being excessively reduced. The best evidence we know on ice dosage suggests applying 10 minute ice combined with 10 minute rest (ie no ice) [4]. Please be aware that this is just a suggestion and all body parts respond differently therefore you should use your own judgement on this one.
Be careful when using ice if you are hyper-sensitive to the cold or have a circulatory issue.
When applying ice it is recommended you do so with it wrapped in damp towel to minimise the risk of skin or nerve damage.
COMPRESSION
Will help prevent further swelling as a result of the natural inflammatory process taking place. It can also reduce bleeding at the area of tissue damage. Elasticated bandages are good as they give comfort without completely constricting blood vessels to the area. Bandaging should always begin distal to the injury and move proximally, overlapping each previous layer by one half.
ELEVATION
Will prevent swelling by improving venous return and reducing hydrostatic pressure. This will result in a reduction of oedema and fasciliate waste removal from the site of injury. If you are elevating the lower limb, you should lie flat with your leg up higher than the level of your pelvis, so position the leg up on several pillows!
So POLICE your acute injury! A balance of appropriate levels of rest, movement and controlled load have bene shown to optimise recovery and healing. Ask your physio for advice if the injury is severe. Give me a call or email me at Onebody Clinic if you need more advice.