Have you ever rolled your ankle or strained your low back and wondered whether you should reach for the frozen peas or the heat pack? Have you put on an old compression sleeve from the back of your wardrobe, not knowing if it actually helps? And how much rest is too much? Managing an acute injury can be stressful, but it doesn’t need to be complicated.
Heat or Ice?
When considering the use of heat or ice following an injury, it’s important to keep in mind that neither have been found to actually enhance recovery and the scientific evidence for their use is limited.
Heat
Heat packs have been found to reduce pain in people with acute low back pain or delayed onset muscle soreness (DOMS). Heat creams and hot showers have no effect on recovery, however they can provide temporary relief for tense and sore muscles. If an injury has caused visible inflammation (e.g. swelling or bruising), heat should be avoided as it increases blood flow to the area, which may increase swelling and pain.
Ice
For years, ice has arguably been the most common strategy for managing acute injuries. Some research suggests that applying ice for short periods of time in the first few hours following an injury may help decrease pain, however overall ice does not enhance recovery or decrease swelling. In fact, the application of ice may actually impede recovery by decreasing blood flow to the area and delaying the body’s natural healing process.
So what happened to RICE?
You may have heard about managing acute injuries with RICE (rest, ice, compression, elevation). This was the most commonly used protocol for several decades, however in 2014 it was retracted by the man who first coined it, Dr Gabe Mirkin. This was due to advances in research that showed that the use of the RICE protocol alone does not improve pain, swelling or function following an injury. Since 2014, several new protocols have been suggested, including PRICE (protection, rest, ice, compression, elevation) and POLICE (protection, optimal loading, ice, compression, elevation). In 2021, the recommended protocol is now PEACE and LOVE.
A little less RICE, a little more PEACE and LOVE
During the first few days, soft tissue injuries require a bit of PEACE.
Protect
Movement that aggravates the injury or increases pain should be avoided for the first 1-3 days. Not only does this help to prevent further injury, it can reduce bleeding in the tissues.
However, complete immobilisation of an injured area and prolonged rest can also be counterproductive. Research into treatment of acute ankle sprains has found regularly moving the ankle in pain-free directions is beneficial and can result in a faster recovery.
Elevation
During this phase, elevating the limb higher than the heart can help reduce swelling. Although the evidence for elevation is limited, there are no adverse effects and as such, it is worthwhile trialling following an injury.
Avoid Anti-Inflammatories
Anti-inflammatory medications, such as ibuprofen, should be avoided during this phase. Our body is very skilled at healing itself and has an impressive healing process. Inflammation is an important part of this process and as such, inhibiting inflammation can delay or negatively affect long-term recovery. If you’re in need of pain relief, ask your pharmacist or GP for advice about other types of pain medication.
Compression
Using bandages, braces or taping to compress the injured area may help decrease swelling and bruising. Again, while there is limited evidence to show compression enhances the healing process, it has no adverse effects and can help improve comfort during this phase. No difference has been found between the type, amount or duration of compression either – so use whatever you’ve got and use it for as long as you like!
Education
Check in with your physio! When it comes to injuries, information is power. Your physio can provide you with a diagnosis, determine whether or not imaging is needed and get you started on some appropriate exercises. Injuries can be stressful, especially if it means you’re unable to work or play sport. Your physio can give you some time frames and advice around returning to your normal activities and help to reassure you about the recovery process.
After the first few days, it’s time for a bit of LOVE.
Load
Keep moving! Research shows that movement and exercise is helpful for most injuries. Loading the injured area without exacerbating pain can help enhance the healing process, as well as improving strength of tendons, muscles and ligaments in the area. Pain and symptoms should help you determine how much movement is enough, as well as when to return to your normal activities.
Optimism
It’s the power of positive thinking! Patients who stay optimistic about their recovery have been found to have better outcomes and prognosis. On the other hand, fear, catastrophising and negative beliefs can impede recovery and result in a different experience of symptoms.
Vascularisation
Aerobic exercise, such as cycling or walking, can help increase blood flow to injured tissues and aid healing. Commencing a form of pain-free aerobic exercise a few days after the injury occurs can improve physical function, help with return to work and decrease reliance on pain medication.
Exercise
In addition to aerobic exercise, specific exercises to treat the injured area are important following an injury. Again, this is where your physio comes in! Your physio will conduct a thorough assessment to determine why the injury happened and to identify what needs to be addressed in order to get you back to full fitness. Exercises for injury rehabilitation may focus on strength, mobility, control or balance and can decrease the risk of reinjury in the future.
In summary:
– Keep moving as much as you can, in whatever way you can, without aggravating your symptoms
– Use ice only if it helps with your pain, but for no more than 10 minutes at a time in the first few hours following the injury
– Stay positive
– Check-in with your physio
__References__
Bleakley, C.M., Glasgow, P. and MacAuley, D.C., 2012. PRICE needs updating, should we call the POLICE?.
Dubois, B. and Esculier, J.F., 2020. Soft-tissue injuries simply need PEACE and LOVE.
Malanga, G.A., Yan, N. and Stark, J., 2015. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate medicine, 127(1), pp.57-65.
Mirkin, G. 2014. Why Ice Delays Recovery.
Van Den Bekerom, M.P., Struijs, P.A., Blankevoort, L., Welling, L., Van Dijk, C.N. and Kerkhoffs, G.M., 2012. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?. Journal of athletic training, 47(4), pp.435-443.
Vuurberg, G., Hoorntje, A., Wink, L.M., Van Der Doelen, B.F., Van Den Bekerom, M.P., Dekker, R., Van Dijk, C.N., Krips, R., Loogman, M.C., Ridderikhof, M.L. and Smithuis, F.F., 2018. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British journal of sports medicine, 52(15), pp.956-956.
