Acute Injury Management
is one of those unexpected events that we have probably all gone through. As it’s quite unpredictable for most, it leaves us extremely frustrated. How, why did this happen? When I speak about acute injury I am referring to sprained ligaments and torn muscles or tendons.
The number one question we ask as patients is (I have been a patient plenty of times), “how long before I’m back?” This can be tricky for practitioners. They want to give a realistic answer and tend to err on the side of caution.
A number of factors will dictate recovery time with any acute injury. Examples of this would be the type of structure injured (muscle vs bone vs ligament vs tendon), how the injury occurred, how dedicated someone is to their rehabilitation, how evidence based the rehab programme is, previous injuries, muscle imbalances, any systemic conditions etc.
However one element of a rehabilitation programme that has been advocated for many years is the PRICE protocol. Price – protection, R – rest, I – ice, C – compression and E – elevation. Despite good anecdotal evidence for its benefits in acute injury (soft tissue) management, there is limited high level evidence for its use. Ice and elevation have both been used to reduce inflammation. Ice is also thought to have an analgesic effect and therefore reduce pain. However, there is little evidence that ice on its own has any benefit. There is evidence for the use of ice with elevation. With compression adding to the protection of the injured structure (my opinion) the RIC in PRIC seems a positive approach. Where some researchers feel the PRICE protocol falls down is in the R – rest.
Some researchers feel an updated approach is needed. They posit the acronaym POLICE would better suit acute injury management. Price – protection, O – optimal -, L – loading, I – ice, C -compression and E – elevation.
They believe optimal loading should replace rest in the price protocol. Loading has been shown to have a positive effect on damaged structures (ligaments, tendons, muscles) at a cellular level, and hence speeds up recovery.
Other studies show that initial rest has a positive effect but resting too long has a negative effect. Unloading may be viewed in the eyes of some as rest, but its not. Unloading and finding the optimal load (amount of work something can do without causing further damage) to encourage the structures natural healing is a precarious task. It should not be a one size fits all. Each individual with similar injuries will have different optimal loads. Finding that and addressing it will lead to shorter rehabilitation time. With this in mind, clinical reasoning would support the acronym POLICE in acute soft tissue management.
In closing, if you suffer an acute injury its very frustrating and will probably keep you out for a few weeks (severity depending). However, it’s not the end of the world. Apply ice (wrapped in a cloth towel) for 10-15 minutes while elevating and compressing it. Then at your convenience go and see your physio/physical therapist. They are best equipped to diagnose and rehab the injury, finding your optimal load so as to increase recovery time.