progress from RICe to POLICE For injury management
Can injuries be more effectively managed by RICE or POLICE?
By Brad Williamson BSc. (Physiotherapy) (Dist.) APAM
The early management of an acute musculoskeletal injury is vital to optimal recovery. Despite its importance there is a widespread lack of knowledge regarding the best acute injury management practices. The acronym RICE is familiar to most people (Rest, ice, compression, elevation) and is a good starting point but it is rather limited and has been expanded upon in recent years. POLICE is a better acronym to remember and is the current benchmark for optimal acute injury management. Let’s have a look at each element.
Depending on the severity and extent of tissue injury the degree of protection and rest required will vary. Whilst it is necessary to mitigate the stress/load damaged structures are subject to over the first days post-injury to prevent further bleeding and injury, it is equally important to recognise that excessive rest has deleterious effects on tissue health. Protection encompasses the use of equipment and tape to support and unload structures along with advice from your physiotherapist as to which activities to continue, which to cease and when to resume exercise.
Optimal loading is the second part of the balancing act between rest and continued activity alluded to earlier. Studies have demonstrated that early loading, through modified daily activities and exercises, facilitate faster recovery through manipulation of mechanotransduction. The optimal amount of mechanical stress placed on healing tissues results in upregulation of beneficial proteins necessary for tissue healing. As mentioned earlier the balance between rest/protection and loading is different for each individual and each injury, as such it requires close cooperation with your physiotherapist to determine an appropriate level of loading and progression to facilitate optimal recovery.
The use of ice is almost universally accepted as beneficial post-injury, however it does not necessarily have the effect on inflammation it is assumed to. The evidence surrounding the use of ice in acute injuries demonstrates that its benefit is largely pain relief rather than acting as an anti-inflammatory modality. Nonetheless, there is definitely benefit to intermittent ice application (20 minutes on; 40 minutes off) over the first 48-72 hours post-injury.
Another misconception regarding acute musculoskeletal injuries is that the inflammatory process is bad or harmful. The inflammatory process is integral to the recovery process, without inflammation there would be no tissue healing. However, there are waste products associated with inflammation, namely swelling (or oedema), which can hinder the recovery process. These waste products should therefore be reduced where possible. Compression is a means of limiting the swelling associated with acute injury, minimal swelling means that injured tissues can more readily receive the oxygen and molecules necessary to recover.
Another means of reducing inflammatory waste products is by elevating the affected area. In doing so the pressure inside the blood vessel is reduced meaning that less fluid is pushed into the surrounding tissues. Ultimately what this equates to is a reduction in swelling. Therefore combining elevation and compression is a potent combination and recommended to mitigate swelling and optimise recovery over the first 48-72 hours post-injury.
POLICE is an updated and more effective approach to acute injury management than the traditional RICE method. The acute injury process should be guided by a physiotherapist as it requires skilled assessment and management to ensure optimal outcomes and prompt, pain-free return to activity.
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