Recently published research suggests that we should modify well-established injury management protocols by introducing mechanical loading of the affected tissues much earlier than previously accepted.
PRICE (Protect, Rest, Ice, Compression and Elevation) has been the recommended procedure to manage injuries in the acute phase although research to support this practice is still lacking. It is widely accepted that unloading of the tissues immediately after injury is essential to allow damaged blood vessels to be sealed and for fibrin mesh to be laid down at the wound site. However, continuing the period of protection and rest may prolong and lead to problems with the repairing tissue. Controlled mechanical stress is required to promote the formation of scar tissue with well-aligned collagen fibres which will withstand the stresses of further sporting activity, rather than randomly arranged fibres with excessive cross links. The key is how to apply tensile loading and positively influence the healing process.
The recommended protocol to follow is now POLICE (Protection, Optimal Loading, Ice, Compression and Elevation) and the optimal loading is the part requiring extensive knowledge of the healing process and how to load the tissues appropriately to enhance the formation of more functional scar tissue. It is therefore impossible to quantify these areas as each injury and its’ severity will require individual and controlled interventions. The Practitioner will decide on Frequency, Rate, Intensity and Duration to create the ‘optimal loading’ needed in each instance. Monitoring client responses will provide the practitioner with feedback to indicate how the tensile strength of the tissue increases over time and how they may alter the interventions to match the healing process.
In order, to follow practice that is both safe, and in the longer term interests of the client, we recommend PRICE for immediate injury-care, followed by POLICE, subject to the knowledge and skills of the practitioner.
Reference:
Bleakley C M, Glasgow P, MacAuley D C (2011) ‘PRICE needs updating, should we call the POLICE?’ British Journal of Sports Medicine 46:220-221
Police step in and help Manage Injuries
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