We all play sport for a combination of reasons with keeping fit and fun the most common. Though by doing so, it can ironically lead to injury, which can curtail both of these. There is nothing more frustrating than picking up an injury, and whilst you can’t make the body heal quicker, there are a few simple steps you can follow which will optimise your recovery. By following these simple, yet proven steps, it will allow you the opportunity to comeback sooner, rather than turning a small innocuous injury into an ongoing chronic one, just because of your initial treatment plan. As well as saving you time and pain, it may also negate you the need to later seek expensive medical intervention from a sports practitioner.
The most common type of injury sustained, and it doesn’t even have to be playing sport, is an acute soft tissue injury. A muscle or tendon strain, or joint ligament sprain are the most common type. An acute injury is defined as a one-off trauma, due to sudden or excessive stress applied to part of the body, generating forces in excess of tolerable loads. Soft tissue structures will respond pathophysiologically with a localised increase in:
– Temperature (Heat)
– Discolouration (usually redness)
– and an escalating ‘loss of function’ due to all of the above factors
These repercussions will usually last for a maximum of 48-hours, depending upon the size and depth of tissue damage, but may in more severe cases continue up to 4 – 6 days! Thus, the most important time for an acute injury is the ‘treatment administered’ immediately after the injury, and the first 12 – 24hours thereafter. I.e. what you do following an injury means YOU have the control to greatly affect the outcome of your injury.
In terms of tissue response, it is the mechanism of injury that matters, not the activity by which it is produced. The nature of the tissue damage will indicate the necessary therapy.
Ideally such injuries should be attended to by a qualified therapist, but this is hardly ever the case because of the location at the time. This though should not be a problem, as the initial treatment plan is generally the same no matter what actual structure is injured.
Often people try to do what they think is best, based on their general knowledge. And with the best intentions they usually get it about half right and three-quarters wrong, because they do the right things the wrong way! Therefore this will help clarify what should be done during this early, yet very important period, after which further professional advice may then be sought, so that a full recovery may be achieved.
The universally accepted procedure for immediate care of an acute injury may be summarised by the acronym: P-R-I-C-E:
Provided by the use of slings, braces and crutches etc. To help protect the injury from further damage, but also prevent further excessive movement causing further trauma or increased swelling. (nb two further tips, when using crutches on stairs use the good leg first to go up and the bad leg first to come down. If only using one crutch/stick, then it should be used on the OPPOSITE leg that is injured!!)
This is vital, in the initial 24-48 hours the injured area should not be ‘loaded’. If fibres have been torn then any further movement will continue to open and aggravate the tear and cause more bleeding. Immediate rest from movement will allow fibres to begin to knit together before further damage is done. No real fitness will be lost in just two days, whereas if the trauma is aggravated then it could take much longer to get back to normal. People are often too keen to ‘test’ the injury, when they probably know already that it is weak, listen to your body. Following 48hours rest, consideration may be given to light movement though still maintaining immobilisation to the injured area.
E.g. Ice pack, immersion, massage applied asap. It doesn’t stop swelling, but helps limit further inflammation by slowing circulation. N.b, If applied too long it has the opposite effect with the body redirecting more blood to the area to try and re-warm, instead use for short periods and repeat. Furthermore ice depresses metabolic activity limiting the demand for oxygen, which is not there, and puts cells into temporary ‘cold storage’. It also has an analgesic effect numbing pain receptors and reducing any protective spasm around the injury.
Research has shown this is THE most important modality applied during this early 0-24hour phase. The misconception is that compression squeezes any oedema (swelling) from the injury, in fact by applying a compression bandage early you are trying to limit any swelling from being allowed to build in the first place. Therefore it is imperative the priority is to minimise the space in which fluid can accumulate, and can be retained after the ice is removed. It should extend at least 3cm above and below the injured area. N.b Oedema will still gain access, including the white blood cells which will aid recovery, but by applying an early compression bandage you are helping to stop the body’s overreaction which invariably occurs.
The injured area should be raised above the torso to control or decrease swelling by reducing blood flow too, and increasing oedema away. Such treatment measures implemented instantly can minimise the consequences of the injury and reduce the recovery time needed to resume full un-inhibited activities and avoid complications therapists are left to deal with when the injury becomes chronic.
There are certain activities that will undermine the effectiveness of the P-R-I-C-E principle, and so should also be avoided for 48hours. These can be summarised by another acronym H-A-R-M:
No after match hot baths. This is the biggest mistake of all, as although it feels good at the time heating of the tissues too soon post injury will heighten the secondary hypoxic effect and increase swelling. i.e, it will cause vasodilation of the capillaries, so allow more oedema to escape into the surrounding tissues around the injury and increase the swelling, which in turn will increase pain, immobility and prolong recovery.
No alcohol with any post match entertainment or socialising. Alcohol is a potent vasodilator substance and could if taken in sufficient quantities cause the risk of bleeding by increasing general circulation. As with heat, it will increase excess swelling at the site of injury.
The primary concern is to stop bleeding, with vigorous exercise then circulation is increased and the risk of further swelling and damage to the original injury is possible.
There should be no indiscriminate ‘rubbing’ of muscles or ‘pumping’ of joints to ‘work out’ the injury, especially at the immediate scene of the injury during, or as a substitute for the examination and assessment. Also avoid immediate use of rubefacient creams or ‘rubs’ since the chemicals involved may turn out to be vasodilatory in effect.
All the measures mentioned can be incorporated into one mnemonic, to help remember all the principle benefits of treatment:
‘PRICE is nice, but don’t HARM the injury’
Remember no injury can be encouraged to heal faster; all that can be done is to encourage favourable conditions for natural repair.
Treatment post 48-hours following trauma is harder to explain because so much depends on the particular nature and location of the injury, as well as the individual themselves. It is during this time that further professional advice should be sought to then enable a full recovery.