Managing an acute injury

Knowing how to immediately look after an injury for the first few days can speed up its recovery. In this blog we look at a more up to date protocol on how to help you manage it.

Many of us are well versed on the R.I.C.E acronym (Rest, Ice, Compression, Elevation). Which eventually was upgraded to P.R.I.C.E (P = Protect). Over the last few decades the advice on the management of acute injuries has rarely been contested. However, with growing research there has been a change in the way clinicians deliver advice on acute injuries to patients. With more recent research there is a new acronym called P.O.L.I.C.E. Standing for Protect Optimal Loading Ice Compression Elevation.

What’s changed?

The term REST can be completely misinterpreted. While it’s important to have a balance of rest AND loading. Too much rest can lead to
deconditioning of tissues, stiffness and weakness. By OPTIMALLY LOADING tissue it provides the right levels of stress to encourage tissue healing, while assisting with the drainage of swelling.

What is the right amount of load?

Firstly, you must listen to the pain and not try to push through it. But if in doubt seek advice from a health professional, whether it be a Dr or Physio. Assessing the injury will help clear any serious problems, like fractures or ruptures. After having the serious issues cleared, you can be guided on the appropriate movements or weight bearing exercises to perform.

If in doubt seek advice from a Health professional

Additionally, to help provide the right loading you may require a moon boot, crutches, brace or strapping for support. Before being gradually weaned off.

Ice

I’ve previously questioned the value of applying ice for reducing swelling. There is growing evidence that shows that we need some swelling to aid in the healing process and  by using ice to minimise swelling, we could be slowing down the rate of tissue healing. 

See: hold the ice in RICE

But using the ice instead to reduce pain, by limiting nerve conduction and lowering tissue temperature. This can be effective within 5-10 minutes of application. Doing this every hour will bring pain levels down allowing you to move or load the tissue as tolerated.

Side note: Make sure you regularly check tissue quality while icing to avoid frost bite.

Compression and Elevation

These two are the least controversial in their benefit of recovery from acute injuries. Having compression helps maintain swelling to a manageable level and the area can still move normally. Making sure the compression is tight but not causing pain or numbness. You can use crape bandaging or a tubigrip.

Elevation, particularly for the lower limb helps again at minimising excessive swelling. While elevated it helps to be gently moving the
area, which also assists with tissue healing and swelling.

Anytime you’re dealing with a new injury it’s important follow the most up to date advice to help you recover as quickly and safely as possible. By seeking physio, we can offer you that guidance and support as you progress. At Fundamental Physio Newmarket, you’ll be thoroughly assessed to identify the extent of your injury, then put on the right treatment plan to help you return to normal activity. 


References

Bleakley et al 2012 PRICE needs updating, should we call the POLICE? Br J Sports Med 

Algafly et al. 2007. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med

Malanga et al 2015. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med

Improving front rack position

Improving the front rack position can help us in so many movements. This page shows a number of stretches that will improve shoulder mobility. and help prevent injury.

This is the second part of the shoulder, expanding on a previous post about 4 important shoulder positions that we should all be aiming to achieve. It’s quite important that you can find these positions comfortably, especially under load, as it will help to limit the risk of injury but also make it easier for you to transition out of it.

So, we’re all now great with our over head position. Can you now transition back down to a front rack? à la thrusters, hand stand push ups or catching the wall ball into the squat. Front rack is the most complexed out of the 4 positions as there are so many structures feeding into that position.

With Front rack most of us struggle with finding that shoulder external rotation to get the hands outside of the shoulders while keeping the elbows high. This helps line the hands into a stable platform for the bar.

The forearms are often tight making it hard for the wrists to fully extend. How many of us get achy wrists after front squats? Create that stable platform with good wrist extension.

Our triceps can also restrict the elbow from going into full flexion. And finally good Thoracic mobility as mentioned in the over head position. It will impact achieving extension and getting the maximum lift through the elbows.

Below are a series of mobility exercises to improve that Front Rack position.


Stick external rotation stretch – Grab a stick, hold it outside the arm. Lift your elbow and pull the stick from underneath your arm, across the body. This will pull your hand out further and you will feel the shoulder wind up. Hold for 1 minute. To take this further by repeating a hold-relax method, pulling the stick inwards for 5 seconds then relaxing further into external rotation .

Banded External rotation – Put the elbow into the band, take the hand on the inside of the band and hold on. Keep the elbow close to your head and drive the arm pit forwards. Hold the stretch for 2 minutes.

Wrist Flexor stretch – Kneeling on the floor, with palms facing away, put your hands down on the floor and take the wrists into extension, moving your body backwards. Hold for 2 minutes. Next get the band and place the hand in the same position. Have the band pull away while doing small oscillating wrist extensions into the stretch. Repeat for 1-2 minutes.

Triceps smash – Excuse the facial expressions in this video, I don’t always look that way! Resting the tricep on the bar while flexing and extending the elbow. Start at the triceps tendon (above the elbow) repeat 10-12 reps then move higher up the muscle. To increase the pain….I mean load, use the band to get fascia tacked down to the bar.

Thoracic Mobility as mentioned above it’s important to extend at the Thoracic below are two basics.