Thursday 22 November 2012

Management of Acute Injuries

So, this post aims to explain the best way to manage an acute injury.
The definition of an acute injury is an injury that has occurred within the last 48-72 hours.

Now, the Association of Chartered Physiotherapists in Sports Medicine (ACPSM) are the leaders in providing the articles for this topic, and had previously released the PRICE principle (1998), which stood for:
  • Protection
  • Rest
  • Ice
  • Compression
  • Elevation
But this has now been superseded by the POLICE principle (2012), also released by the ACPSM, which stands for:
  • Protection - protection is designed to protect the injury from any further damage. The amount of protection is dependant on the injury, but supports the joint while recovery takes place. Protection can take many forms, such as bandage, splints, tape or brace

  • Optimal Loading - this is the difference from the old PRICE principles, which means that rest needs to be balanced with a incremental rehabilitation structure that slowly introduces the injury to varying degrees of stress. This will mimic the natural mechanical strains imposed on the injured structure and promote healing in a functional and optimal fashion.

This does not mean that the use of crutches or braces cannot be used (as would have been previously using the Rest principle) as they could well be key in regulating the amount of load through the injury.

  • Ice - Ice has always been used traditionally, as it:
    •  reduces pain (by increasing the threshold required for the nerve cells to send a pain stimuli, and by reducing the speed at which the stimuli is sent), 
    • reduces spasm (which prevents further damage to tissues, and reduces the oxygen demand for the tissue), 
    • reduces metabolism (therefore reducing the oxygen need in surrounding tissue so reduces damage caused by hypoxia and reduces total debris in the tissue. Also, less oxygen supplied to the tissues means less secondary damage to other tissues) ,  
    • reduces blood flow (via vasoconstriction), and  
    • reduces swelling (via vasoconstriction of the blood vessels and increasing the viscosity of the blood).

  • Compression/Elevation - Compression and elevation is to reduce the swelling and limit blood flow to the area when not icing the affected area. This aids venous return so that fresh blood can be introduced to the area, bringing with it fresh nutrients for the healing process, and getting rid of the debris from the injured site.

Never compress and elevate simultaneously, as this can compromise blood flow to the affected area!

Notes for using ice:
  • Always have a barrier between the ice and skin such as a towel or polythene bag etc to prevent ice burn
  • Ice should be in contact with the site for maximum 20 minutes at a time, with around 2 hours between each administration
  • While ice reduces pain, this does not mean that the site is healed
  • Muscles take a lot longer to warm up than they do to cool down - take care with any exercise or activities such as driving up to 4 hours after icing a muscle
  • Check sensation around the area before applying ice - reduced sensation means the person may not feel if there is problems with the area the ice is applied to i.e. ice burn etc
  • Do not apply in the chest area due to cold blood around the heart
  • Do not apply to someone with high blood pressure, as the vasoconstriction will cause their blood pressure to increase further   

Remember! Every injury is different, and this is by no means a "one fits all" programme, it is merely advice to guide a better recovery. Every injury, and the time it takes to heal, is unique.
 Bleakley CM, Glasgow P, MacAuley DC 2012 PRICE needs updating, should we call the POLICE? British Journal Sports Medicine 46:220-221
(See below)

MacKenzie, B. (2000) Cryotherapy 

ACPSM, (1998). Guidelines for the management of soft tissue injury with protection, rest, ice, compression and elevation (PRICE) during the first 72 hours: The Chartered Society of Physiotherapy.


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