Immediate injury management – the basics

03 Sep Immediate injury management – the basics

You may know of RICE (Rest, Ice, Compression, Elevation) as the acronym for what you do immediately after an injury. There are variations of this RICED (D– Diagnosis), PRICED (P– Prevention) and there are even ones for what you don’t do – HARM (Heat, Alcohol, Run, Massage).

More recently there are some new ones POLICE (Protection, Optimal Loading, Ice, Compression, Elevation) and PEACE (Protect, Elevate, Avoid anti inflammatories, Compress, Educate). So which one do you use? Largely it doesn’t matter as long as you understand what you are trying to do.

All tissues have a capacity to take load. It doesn’t matter if its muscle, ligament or bones. As long as you are doing activities within that loading capacity there are no problems. However, if you go beyond that limit, the structure will be damaged.

Understanding what happens helps understand why we do things. Let’s take a sprained ankle as an example. You land from a jump awkwardly and your ankle rolls. The ligament which is meant to control the movement gets overloaded and damaged. We can’t do much about this now (but a good prevention program will) so we have some initial damage. If you keep putting pressure on the area more damage will occur, so you need to stop what you are doing (Rest / Protect).

Virtually all soft tissues (muscle, ligament, tendon) have a blood supply. This gets disrupted with an acute injury causing bleeding. The bleeding causes swelling which starts to cause damage to some of the healthy tissue surrounding the injury. We want to limit this, as more damage to tissue means a longer recovery (Rest/ Compress/ Ice/ Elevation).

After a few days the bleeding is generally under control and the healing process begins. We know that movement is good for healing, but it has to be done in a controlled way (Optimal Loading). We also know that certain things can interfere in the healing process – anti-inflammatories (Avoid anti-inflammatories). When it comes to ice, things can become slightly confusing. Ice is thought to be a mild anti-inflammatory, but it is also good for helping to control swelling and provide pain relief especially in the initial 48 hours. The simple solution is to use it initially then wean off it over 48 hours.

The final E (Educate) you have just done reading this. If you know what and why you are doing things you improve your chances of a better recovery.

Hamish Ashton – Sports Physiotherapist