This is a question that I hear often from my patients - or more accurately – What should I have done when I got injured?
The guidance for management of the initial (or acute) stages of an injury has changed over the years from ICE (Ice, Compression, Elevation) to RICE (Rest, Ice, Compression, Elevation) to and then to PRICE (Protect, Rest, you know the rest).
More recently to the acronym POLICE (Protect, Optimal Loading, Ice, Compression, Elevation) has been used as the importance of active recovery became better researched and understood. This model acknowledges the need to load the injured tissue in the optimal way for recovery, enabling the healing process to be stimulated.
Optimal loading has been defined as ‘the load applied to structures which maximises the physiological adaptation’ or in simple terms if you make the repairing tissue do, to some extent, what I will do eventually the injury will heal in a way that allows better function.
Let’s take a rolled ankle and a ligament sprain for example. If we completely offload the ligament by immobilising it while it is healing, the way new fibres are built may not help the overall function of the ligament, resulting in an ongoing weakness and a greater potential for re-injury. However, if we apply a load the new fibres will ‘learn’ to function in the same way as the existing ligament, thus minimising or eliminating any residual weakness once healing is complete.
Of course, the extent to which the structure is loaded will vary as healing and rehabilitation progresses, hence the term optimal loading. Overloading in early recovery may prevent recovery or further damage injured tissues, whereas under loading may be ineffective.
While POLICE considers rehabilitation, it has been suggested by authors writing for the British Journal of Sports Medicine, that this acronym should also be superseded and replaced with the two-word acronym PEACE and LOVE for optimal recovery.
Cleverly, this covers both the initial, or acute, phase of injury (PEACE) and the rehabilitation (LOVE).
Hence this advice is that immediately following injury (for 1-3 days)
Protect – unload the tissue to prevent further injury – but movement should be encouraged to aid the healing and should be guided by pain
Elevate – to higher than the heart - this promotes drainage of inflammatory fluid through gravity.
Avoid anti-inflammatory actions – some degree of inflammation is beneficial to healing – allowing nutrients and immunological cells into the area. Taking large doses of anti-inflammatory medication can interrupt this process and potentially delay or impair tissue healing. Even the action of ice has been questioned as it may adversely affect the movement of blood to the area, and therefore also the nutrients and specialist cells required for recovery.
Compress – this will reduce some swelling and improve how the area feels
Educate - The injured person should be educated to the need to move and the benefits of movement and early (controlled) use of the injured tissue in order to maximise the healing process. The days of recommending complete rest are (in most cases) gone.
After the first few days the injury needs LOVE
Loading – in general optimum loading is the sufficiently to promote tissue repair in a way that increases the capacity of the structure, such as a muscle, without causing a worsening of the pain. This can be tricky to get right – a professional such as an osteopath can help with this.
Optimism – Research has shown that patients who are pessimistic about the outcome of healing will in general do worse than those who are optimistic. Be positive and confident about the outcome – you are more likely to engage in the appropriate activity and make a better recovery!
Vascularisation – Injured tissues need blood flow in order to heal and cardiovascular exercise can help this. It should be pain free so a cardio exercise which doesn’t rely on the injures tissue is ideal.
Exercise – a program to mobilise and strengthen the injured area is the best approach to ensure long term healing rather than a short term fix and to stop the same injury occurring again. It could be worth getting some professional help from your osteopath to design a plan for you and to monitor your progress.
It should be noted that NICE guidelines recommend PRICE for management of acute, non serious, injury, however PEACE and LOVE could be a considered a more comprehensive approach.
When deciding how to manage your strains and sprains it is advisable to obtain some expert professional help.
At Ian Thornley Osteopathy we are well placed to provide this and will be able to make an assessment of your injury and guide you through the healing and rehabilitation process to ensure you return to health with the repaired tissue in the most robust and functioning state possible.
You can book online or call 07738017206. We can usually see you within a day or two and start you on the road to recovery.
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