While in the ideal world we’d all survive the season without any acute injuries, this unfortunately is not always the case. Over the years the guidance on how to treat acute injuries has gone through various phases despite a lack of high quality evidence. From RICE (rest, ice, compression, elevation), to RICER (rest, ice, compression, elevation, rehab), to PRICE (protection, rest, ice, compression and elevation) and more recently a new acronym has been proposed: POLICE (Protect, Optimal Loading, Ice, Compression, Elevation)

Protect

Protection and rest immediately after an injury are important to prevent further injury. A short period of unloading the tissue and avoiding exercise can be helpful, but longer periods of rest can result in deconditioning and adverse changes in the tissues. So while Protection of vulnerable tissues remains an important principle, too much emphasis creates a default mindset that loading has no place in acute injury management. Rest may be harmful and inhibit recovery. The secret is to find the ‘optimal loading’. The timing of progression from “protection” to “loading” will vary depending on the type and severity of injury as well as the individual athlete.

Optimal Loading

As soon as you’re able to start moving without too much pain, you should. Finding the balance of how much to do and what type of loading can be tricky. Optimal loading means replacing rest with a balanced rehab program. Examples of early loading might simply include a plan of how to wean off crutches. Optimal loading is an umbrella term for any mechanical therapy intervention and can include not just exercised based rehab, but also manual therapy techniques like passive motion, stretching and massage aiming to restore range and function earlier.

An experienced clinician who understands your specific sport can help to guide you through what level of loading, and what type, is “optimal” for you and your particular injury. This will be different for every athlete and should be adjusted accordingly. The key challenge is finding the balance while tissues are still healing. If you go too hard, too early after an injury, you may risk re-injury, increase bleeding and further damage. If we wait too long to get you moving then you may be slowing down your recovery and return to sport. Expert assessment and advice can be very helpful in helping to find that “sweet spot” which is Optimal Loading.

Ice, Compression, Elevation

While more research is needed to confirm the use of compression and elevation, they are currently still a mainstay of acute injury management. Ice has traditionally been used for its analgesic (pain relief) effect and combined with the lack of side effects (in comparison to some common medications), seems to be enough reasoning for us to keep Ice in the mix of strategies.

It’s never too early to begin your rehab. Seek advice quickly after any acute injury to put together a plan to get you back to sport. Click here to book in with one of our clinicians

References:

https://bjsm.bmj.com/content/46/4/220