For decades it has been known that if injured, you follow the R.I.C.E (R) protocol! But times change, evidence moves on, and good therapists admit that patient information needs to change with it!
So what has changed?
R.I.C.E.(R) is;
R for REST. I for ICE. C for COMPRESSION. E for ELEVATION. (R) for REFERAL.
P.O.L.I.C.E is;
P for PROTECT. Protection involves may include use of crutches, casts, braces, taping etc. to help protect the injured area as it heals. This part is designed to prevent excessive loading in the early stages, and so replaces out and out “rest”, which is completely subjective – we have to be realistic with this and accept that most of us aren’t full time athletes, and so “rest” unfortunately will be relative to your job/daily activities etc. If you are struggling to weight bear you need to make sure you’ve had your injury checked out. Rest should be of limited time, ideally restricted to immediately after trauma. Undue long rest can have negative effects, producing “adverse changes to tissue biomechanics and morphology” (Ref 1).
OL for OPTIMAL LOADING. Research shows that “Progressive mechanical loading is more likely to restore the strength and morphological characteristics of collagenous tissue. Indeed, early mobilisation with accelerated rehabilitation is effective after acute ankle strain. Functional rehabilitation of ankle sprain, which involves early weight-bearing usually with an external support, is superior to cast immobilisation for most types of sprain severity” (Ref 1). What this means is that by optimally loading injured tissue, we can stimulate the healing process as bone, tendon, ligament and muscle all require some loading to start the healing process. Anyone that has been in my clinic will know this fits my biases quite nicely! But what is “optimal”? Of course – as is life – its about finding a balance –“Optimal loading means replacing rest with a balanced and incremental rehabilitation programme where early activity encourages early recovery. Injuries vary so there is no single one size fits all strategy or dosage. A loading strategy should reflect the unique mechanical stresses placed upon the injured tissue during functional activities, which varies across tissue type and anatomical region” (Ref 1).
Do we want to load a broken bone on day one? Maybe not. If in doubt, seek professional medical help to form a structured loading plan.
I for ICE. People are always surprised to hear that the research behind the use of ice is far, far from conclusive – see my blog here. There is certainly a lack of quality research and very little guidance in terms of how ice can be best utilised but as seen in the aforementioned blog, there is evidence for its use. Most of us have a personal experience of using ice, and it can be highly effective for reduction of pain post injury. A bag of frozen peas is my weapon of choice (a tin doesn’t work anywhere near as well….).
C for COMPRESSION. Again, very limited quality evidence to fully support compression, but putting pressure on the injured area can help in reducing swelling. This can be quite a fine line; the more pressure applied, the lower the amount of blood that can pass to the injured limb. However, cutting off the blood supply to the extremity of a limb completely can have negative effects. If the limb goes numb at all, the bandaging should be released. A tubi-grip is your safest bet.
E for ELEVATION. Place the injury so that it is higher than the heart, where possible. Can be combined with non weight bearing movements.
So as you can see, the last 3 have changed very little, other than to admit we know less than we thought we knew. As for pain management, and anti-inflammatories, certainly for the initial acute period (48-72 hours) I do not recommend the need for NSAIDS. If pain relief is needed, then paracetamol and ice should suffice. Impress your mates by telling them you are carrying out Cryotherapy!
If you are suffering from an acute or chronic injury, please contact Dan@DC-InjuryClinic.co.uk.
REFERENCES
Ref 1 http://bjsm.bmj.com/content/46/4/220.full.pdf
N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt be seen as such. They are merely guides to a better understanding of how our bodies work.