The traditional model for managing a new musculoskeletal injury has recently shifted from PRICE (Protect, Rest, Ice, Compression, Elevation) to POLICE (Protect, Optimal Load, Ice, Compression, Elevation) in recent years. The shift allows you to enjoy the benefits of early activity and exercise while minimizing complications that may arise from pure “Rest” [1,2].
Protect
Braces, splints, casts, and slings can be used to protect your injury in the early stages of recovery. The type of protection depends on the severity of your injury and the type of involved tissue(s) [3-5]. Flexible braces can be used for minor injuries while rigid braces will be used for more severe injuries involving your joints, muscles, connective tissues and nerves. Casting may be indicated if a bone fracture is discovered. If a brace is indicated, your physical therapist (PT) can help determine which is best for your injury and activity levels. If a cast is necessary, an orthopedic specialist will design one that allows as much movement as possible while immobilizing your fractured bone so it can heal properly.
Optimal Load
Most tissues can be loaded in a variety of ways soon after an injury has occurred [3-6]. Just like the selection of protective bracing, the type of loading depends on the injured tissue and severity of your injury. Your PT will let you know which of your activities should be avoided and which activities to continue. You will also be guided through an exercise program that speeds up the recovery process. Doing nothing should never be an option. Pure “Rest” can lead to deconditioning, muscle weakness, and joint stiffness which prolongs the recovery process [7].
Ice
STOP! If you are experiencing any burning, tingling, or numbness, you may have injured a nerve. Icing a nerve injury can delay recovery [8]. Your PT will provide you with alternative strategies for nerve pain relief.
Following a new injury, icing can be an effective strategy for relieving pain and slowing down the inflammation process [7,9]. Ice should be applied for 20 minutes every 2 hours in the first 2 to 3 days of injury. A wet towel should be placed directly over the injured area. Then, place an ice pack on the wet towel. This strategy can also be used in the later stages of recovery to reduce the adverse effects of exercise and activity. For example, you can ice at the end of the day after you have completed your activities, home exercise program, and compression therapy.
Compression
STOP! Do not wear your compression garments while sleeping unless it is recommended by a medical professional!
Compression garments are useful at all stages of injury [10,11]. They reduce and prevent swelling and inflammation. Some braces work by providing compressive support. Otherwise, your PT will help you find and fit the compression materials that suit your injury and activity goals. They can be worn all day during the initial stages of injury. Later in the recovery process, they should be worn during intense activity and for at least 60 minutes after completing exercise [11]. This strategy reduces the risk of adverse effects that can occur from the gradual increase of load on your injured tissues.
Elevation
STOP! If you start to experience any tingling, burning, or numbness while elevating your limbs, return to a comfortable position right away.
The elevation of an injured limb harnesses the power of gravity and your circulatory system to reduce swelling and inflammation [12]. If you have a lower-body injury, it is best to lay down and prop your leg above the level of your pelvis, at least [11]. If you have an upper-body injury, you want to prop your arm above the level of your heart. Your PT can help find the position that is most comfortable for you.
For any further information, please contact Christian Reyes, christian@postpt.com
References
1. Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE? Br J Sports Med 2012;46(4):220–1.
2. Glasgow P, Phillips N, Bleakley C. Optimal loading: key variables and mechanisms. Br J Sports Med 2015;49(5):278–9.
3. Järvinen TA, Järvinen TL, Kääriäinen M et al. Muscle injuries: optimising recovery. Best Pract Res Clin Rheumatol 2007;21(2):317–31.
4. Kerkhoffs GM, van den Bekerom M, Elders LA et al. Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. Br J Sports Med 2012;46(12):854–60
5. Kaminski TW, Hertel J, Amendola N et al. National Athletic Trainers’ Association position statement: conservative management and prevention of ankle sprains in athletes. J Athl Train 2013;48(4):528–45
6. Glasgow P, Phillips N, Bleakley C. Optimal loading: key variables and mechanisms. Br J Sports Med 2015;49(5):278–9.
7. Järvinen TA, Järvinen TL, Kääriäinen M et al. Muscle injuries: biology and treatment. Am J Sports Med 2005;33(5):745–64
8. Bassett FH, Kirkpatrick JS, Engelhardt DL, Malone TR. Cryotherapy-induced nerve injury. The American Journal of Sports Medicine. 1992;20(5): 516–518.
9. Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sports Med 2004;32(1):251–61.
10. Tomchuk D, Rubley MD, Holcomb WR et al. The magnitude of tissue cooling during cryotherapy with varied types of compression. J Athl Train 2010;45(3):230–7
11. Brukner P, et al (2018). Clinical Sports Medicine, Volume 1: Injuries. Chennai: McGraw-Hill.
12. Järvinen TA, Järvinen TL, Kääriäinen M et al. Muscle injuries: optimising recovery. Best Pract Res Clin Rheumatol 2007;21(2):317–31.
