New injuries are an unfortunate part of life particularly for those of us involved in sports. There is so much information around and it often changes. I struggle to keep up and it’s my job to teach this stuff as well as helping patients!
So we are all told to take it easy with a new injury, which kind of makes sense at first; things are painful and the body needs to recover… which is true and fine short term. However, it really doesn’t take long for us to start to lose strength and fitness. Imagine a leg in a cast after a break. You can see how much muscle bulk has been lost in a short time. That is an extreme example, but the principle holds true.
Our bodies are made to move and respond a lot better to movement then total rest. This is where “optimal loading” comes in. This doesn’t mean not overdoing it and ignoring pain. It involves a happy medium between total rest and full activity. A different form of exercise will keep you fit and strong whilst promoting good circulation to help an injury heal. This is where the saying ‘POLICE’ started from to replace ‘RICE’. ‘POLICE’ stands for: Protect Optimally Load Compress Elevate, which is a very successful strategy……. but now the new kids on the block are ‘PEACE’ and ‘LOVE’.
This new way of thinking identifies the psychological effect injury can have, which is the main barrier to return to sport as well as a big predictor of future injury. (In fact, fear of injury is likely to lead to injury for a whole host of reasons.) It looks at the immediate actions PEACE and the longer-term rehab strategy LOVE.
Immediately after a soft tissue injury, do no harm and let PEACE guide your approach:
P for Protect
Unload or restrict movement for 1 to 3 days to minimise bleeding and prevent further injury. Rest should be minimised as prolonged rest can compromise tissue strength and quality. Rely on pain signals to guide removal of protection and gradual reloading.
E for Elevate
Elevate the limb higher than the heart to promote interstitial fluid flow out of tissue. Despite the fact the science behind this is patchy at best, its free and easy to do and will not do any harm.
A for Avoid anti-inflammatory modalities
Anti-inflammatory medications may potentially be detrimental for long-term tissue healing. The various phases of inflammation contribute to optimal soft tissue regeneration. Inhibiting such an important process is not recommended as it could impair tissue healing, especially when a higher dosage is taken. They also have lots of other side effects on digestion and the heart.
Despite widespread use among clinicians and the population, there is no high-quality evidence on the efficacy of ice for treating soft tissue injuries, it won’t affect swelling but might be a nice painkiller short term.
C for Compress
External mechanical pressure using taping or bandages helps limiting swelling, despite conflicting studies, compression after an ankle sprain seems to reduce swelling and improve quality of life. Yet again we don’t really know how well this works but its easy to do and safe.
E for Educate
Therapists should educate patients on the benefits of an active approach to recovery. Passive modalities such as electrotherapy, manual therapy or acupuncture, early after injury has a trivial effect on pain and function compared with an active approach; it may even be counter-productive in the long term. Better education on the condition and load management will help avoid overtreatment which has been suggested to increase the likelihood of injections or surgery. We can still offer support and pain relief as well as addressing any other areas that may be effected, but short term our role is education, first aid and empowering patients to care for themselves.
After the first days have passed, soft tissues need LOVE
L for Load
An active approach with movement and exercise benefits most patients with musculoskeletal disorders]Mechanical stress should be added early and normal activities resumed as soon as symptoms allow. Optimal loading without exacerbating pain promotes repair, remodelling and building tissue tolerance and capacity of tendons, muscles and ligaments.
O for Optimism
The brain plays a key role in rehabilitation interventions. Psychological factors such as depression and fear can be barriers to recovery. They are even thought to explain more of the variation in symptoms and limitations following an ankle sprain than the degree of damage! Pessimistic patient expectations are also associated with suboptimal outcomes and worse prognosis. While staying realistic, practitioners should encourage optimism to enhance the likelihood of an optimal recovery.
V for Vascularisation
Pain-free cardiovascular activity should be started a few days after injury to boost motivation and increase blood flow to the injured structures. Early mobilisation and aerobic exercise improve function, work status and reduce the need for pain medications in individuals with musculoskeletal conditions.
E for Exercise
The right kind at the right time has amazing long-term results!
Managing soft tissue injuries is more than short-term damage control. Similar to other injuries, clinicians should aim for long-term outcomes and treat the person with the injury rather than the injury of the person! Its not a one size fits all approach, and a tailored exercise and rehabilitation plan can really get you back on track quickly!
Remember – the team at Shefford Osteopathic Clinic are here to treat sports injuries, alleviating pain and optimising recovery time.
This article is written by Andrew MacMillan, a registered osteopath with Shefford Osteopathic Clinic.