Common questions I get asked when an injury has occurred is "am I too early to see the physio? What if I just wait for a couple of weeks to see if it goes away? My GP recommends I rest for this week and take some pain killers, what should I do?".
I think there are a number of reasons the perception may be to wait, one being the popular (though perhaps outdated) acronym RICE - Rest, Ice, Compression, Elevation, used to assist with acute injury management. The ICE component still holds up, but the "rest" component is relative. There is likely also a lack of awareness just how to tackle an acute injury, and when there is significant pain it feels logical to wait for that to reduce first. Here is an overview of the reasons getting early advice and treatment is crucial to good recovery.
When we sprain an ankle for example there is initial pain and swelling, and if it is severe enough will be difficult to put weight on that leg. The degree of injury can vary significantly from a mild ligament sprain to significant ligament tearing. The same can be said for other acute injuries such as a hamstring tear while sprinting, shoulder injury after falling on an outstretched hand, or a low back sprain while gardening.
Do we rest all of these the same, and what does rest mean anyway? Again it is relative to the injury sustained. A mild ankle sprain that has not had weight bearing for a long period of time, say a week or more, has a poorer long term outcome than those who appropriately load the ankle and reduce swelling at the same time.
Instead of thinking RICE, we need to use POLICE - Protection, Optimal loading, Ice, Compression, Elevation. By replacing rest with protection and optimal loading, we can give the injured tissue every opportunity to heal well and return to normal function.
Protection (rest) rarely means do nothing. There are a number of ways to reduce the load on injured tissue other than resting completely. Things like use of crutches, taping, activity modification, water therapy and so on. Excessive inflammation from too much too soon is to be avoided however, and will contribute to an overactive inflammatory response.
The inflammatory response
The body has a remarkable way of healing itself. When we get an injury to tissue (ligament, muscles etc) our immune system kicks into gear. With it we get increased blood flow to the injury site (inflammation) in order to get rid of dead cells and for healing promoting cells to get in. Our bodies commonly over-do this process and swelling can be detrimental if excessive.
As soon as swelling is controlled and optimised, we need to consider loading the injured area appropriately.
Inadequate loading will not sufficiently stimulate the tissue for best healing. It is a fine line that requires careful assessment and appropriate advice, as soon as possible after injury.
A mild or moderate ankle sprain that has not had adequate weight place on it for two weeks will cause joint stiffness, muscle weakness and reduced proprioception. Likewise, it is common that an athlete with a hamstring tear should return to jogging within 2-3 days. When done appropriately, we can find the right balance of protect and load for a great outcome. Ideally being able to move as normally as possible is important early after injury, as long and pain and swelling are not significantly increasing.
A BIT ABOUT PAIN
It is often not appropriate to wait for the pain to resolve first before treatment and returning load to the injured area, since pain is highly variable and can have many contributing factors that are not related to tissue damage. In fact, waiting for pain to go away completely before loading injured tissue is likely not going to happen. If it does, as soon as you "re-load" the injured area the body will not tolerate it, and pain will quickly return and likely hang around for a lot longer.
ICE, COMPRESSION, ELEVATION
Icing helps to cool the injured site, assist in pain relief within the first 2-3 days, and helps recovery. Applying regularly (no right or wrong here, many advocate for 20 minutes every 2-3 hours) in the first 24-48 hours after injury can be helpful. There are minimal negative effects of regular icing, but watch out for skin burn if you leave on for too long. On a side note, I used to set an alarm to ice in the middle of the night to make sure it is done regularly. I would advise getting your sleep as a priority for recovery, and manage swelling in the waking hours. Compression bandages and other garments like compression socks or stockings can be really effective in managing swelling by restricting blood flow to the area. Keep compression on for as long as there is swelling present. Elevation means we use gravity to assist blood flow reduction to the injured site. Lower limb injuries are more likely to benefit from "putting your feet up".
- The body has an impressive ability to heal itself, but can often over do the inflammatory response
- By replacing RICE with POLICE principles means we can find the right balance of tissue protection, tissue loading and swelling reduction in order to get the best outcome after an injury.
- A physio is highly educated and trained in acute injury management and is the right person to see following an injury, the sooner the better.