Sprains, strains and muscle pulls, we’ve got them covered.
Ideally, we would all avoid acute injuries, ankle sprains, knee sprains the odd muscle pull, but in reality, musculoskeletal injuries can be part of everyday life. Advice can be confusing and conflicting so we have looked at the latest research, and coupled this with our years of clinical experience. So here is your guide on what to do when things go wrong.
RICE, PRICE, and now POLICE!
Over the years the guidance on how to treat musculoskeletal injuries has gone through various phases. From RICE (rest, ice, compression, elevation) to RICER (rest, ice, compression and elevation, rehab), to PRICE (protection, rest, ice, compression, elevation). But even PRICE is now outdated and researchers (Bleakley, Glasgow and MacAuley 2011) are suggesting POLICE (protection, optima loading, ice, compression, and elevation) as the gold standard combined method of managing acute soft tissue injuries. So POLICE it is then, let’s look at what this means for you and your swollen, painful appendage.
Protection
Protect emphasises the importance of avoiding further damage to ligaments, tendons, or muscles. If moving or loading (putting weight through the affected area) causes excess pain it is advisable that immediately after the injury you should unload (by taking the weight off it) and rest for 24/48 hours. But it doesn’t imply definite immobilisation. For example for a lower limb injury, you may consider using crutches, allowing you to continue through your day in a relatively normal way whilst ensuring you don’t make your injury worse.
Optimum Loading – Not Rest!
Optimal loading means replacing rest with gentle motion while you are in the protection phase. Once you can start moving replace rest with a balanced rehab programme which may include simple range of motion exercises, stretching, and massage, all aimed at restoring the range and function of the injured area earlier. Optimum loading will stimulate the healing process as bone, tendon, ligament and muscles all require some loading to stimulate healing (Glagow, Phillips, Bleakley 2015) The key challenge is finding the right balance whilst tissues are healing. An experienced clinician who understands your specific injury will guide you through this phase ensuring not to
go too hard and risk re-injury, bleeding and further damage but similarly not waiting too long to get you moving which in turn may result in a delayed recovery due to muscle and joint stiffness and even muscle deconditioning which can occur with prolonged rest. (Wangt ZR, Ni Gx 2021)
Ice, Compression, Elevation
While more research is needed to confirm the use of compression and elevation, they are currently still a staple choice of treatment for acute injury management. Providing you have no altered sensation applying an ice pack wrapped in a damp towel ( to prevent ice burns to the skin) to the affected area for 10-20 minutes every 2 hours over the first 24-48 hours can assist in pain relief and reducing excess swelling which can impede recovery. In addition to ice application, you can apply compression to the injured joint or muscle with an elastic bandage such as a tubigrip, which should serve to reduce excess swelling. Lastly, keep the affected area elevated ( above the heart if possible) this will help with further reducing the accumulation of oedema and will maintain good circulation around the area which may help reduce the likelihood of joint stiffness.
Conclusion
Whilst the most successful principle in injury management is to avoid them that may not always be possible! By this, I don’t mean hanging your running trainers or football boots up and packing away your cycle helmet. I mean committing to activity-specific exercise to minimize your risk of injury in the first place. However, if you do find yourself on the receiving end of a nasty sprain or strain the POLICE (protect optimal loading, ice, compression, elevate) principle is the recommended way to treat a musculoskeletal injury. One thing is missing from our age-old trusty RICE (rest, ice, compression, elevate) principle. REST. The key behind this change in advice is that while rest is important, it should only be for a limited period after injury and that too long can inhibit recovery and a programme of optimal loading is now recommended.
Take Care, Helen
Helen Manders BSc(Hons) MCSP HCPC
