An acute injury is often defined as a sudden injury that has occurred as a result of a traumatic event. For example, imagine the situation: You wake up and it’s a beautiful day. In your eagerness to get outside, you run down the stairs, trip on the last one and land on the outside of your ankle. Within minutes you have a painful and swollen ankle.

Acute injuries aren’t always a result of trauma; they may also result from repetitive strain or repetitive microtrauma resulting in an inflammatory response. After running 10km, you might start to feel a mild pain on the outside of your knee, and after 5km more you can hardly walk. What do you do?

Firstly and most importantly: After any trauma, if you have signs and symptoms of any serious injury, I would recommend a professional opinion. Signs and symptoms include deformity, severe pain and/or swelling and an inability to bear weight. If in doubt, check it out. You may need an X-ray or further investigation.

Some of you may have heard of the acronym, PRICE, when it comes to acute soft tissue management. PRICE stands for Protect Rest Ice Compression and Elevation. Recently however, in the British Journal of Sports Medicine, Bleakley et al have replaced the R (rest) in PRICE with OL or Optimal Loading, turning the acronym into POLICE.

What is POLICE? Let's start with OL or Optimal Loading:

Optimal Loading means placing the best possible amount of force through the injured area in order to stimulate and improve tissue healing, promoting early recovery. Evidence has shown that short periods of rest may be useful immediately after injury; however this should be of limited duration. Too much rest can be harmful and may produce undesirable effects to the healing tissue.

 Naturally, it has also been shown that too much force or aggressive exercise can be harmful to an injury and should be avoided. In addition, ignoring pain can often worsen the situation, causing a longer rehabilitation period.

The question is - how much force is too much? The answer - listen to your bodies. Pain is a good indicator here. Although this isn’t an exact science, I often tell my patients, when rehabilitating, to use a scale of 10 and not to push themselves to more than 2-3 out of 10 (10 being the most painful). After loading the structure, you should not have additional pain for more than an hour or two; otherwise you have probably overdone it.  

One of the tips which may be able to help you rehabilitate faster is the P in POLICE which stands for Protection of the injury site. In less serious injuries with minimal pain, taping may help protect the area and allow you to mobilize pain free. For more serious injuries, crutches or a brace may protect the area and help the patient to rehabilitate more rapidly and with less pain.

Figure 1: Protection: Rigid taping for a basketball player with a mild ankle sprain, enabling him to play.

Ice:

Using ice is perhaps the oldest and simplest method in the treatment of an acute injury. It has been proposed that by reducing the tissue temperature, ice can decrease pain, tissue metabolism and muscle spasm, thereby diminishing the inflammatory process and aiding recovery. Probably the best study on ice application is by Bleakley et al, 2006, (Cryotherapy for acute ankle sprains: a randomized control study of two different icing protocols). They suggest that intermittent ice application involving 10 minutes of ice, 10 minutes off and 10 minutes on again every 2 hours, should be repeated for the first 72 hours after injury. Make sure the ice is not touching the skin. Wrapping it in a wet towel is best.

Compression and Elevation:

Evidence on Compression and Elevation is far from conclusive; however, I have found that both work to reduce swelling and alleviate pain. Physiotherapists have special bandages that can help with swelling. If using your own bandage make sure it’s not too tight and that there is still blood circulation flowing below the bandage.

There are also some things which should be avoided in the first 72 hours after an acute injury. Anything which increases the blood flow to the injured area should be steered clear of. For example, avoid putting heat on the injured area, especially if it is swollen. Drinking alcohol should also be avoided as alcohol is a vasodilator.

 A lot of injuries heal by themselves; however physiotherapy is often useful to speed up the healing process. In addition to the above modalities, physiotherapists often employ the use of electrotherapy to help soft-tissue healing. One example of electrotherapy is ultrasound. Ultrasound is thought to enhance the natural ability of the body to stimulate and control the healing and reparative process.

In conclusion, using the above principles to manage your acute injury will result in a quicker healing process and a stronger, healthier repair.

Jodi Hurwitz (MSc. Physiotherapy, University College London), has a private practice in Tel Aviv. www.physiotelaviv.com