Acute Management Injury/Pain.
The following section is evidenced based information and advice which patients may find helpful in the self management of an acute (under 6 weeks) injury or onset of pain.
Acute Soft Tissue Healing
If you have had an acute onset of pain it is possible that there
may have been minor soft tissue injury that has occurred and is
contributing to the onset of the pain.
Once soft tissue damage has occurred there is a well-recognised
healing process. This is summarised in the graph below:
This applies to musculoskeletal tissue including muscle,
ligament and joint tissue such as joint capsule or disc.
Soft tissue healing can take up to 6-12 weeks. This means that
your pain can take this length of time to improve. In 60-90% of
patients their pain will fully resolve within 12 weeks.
Management of Acute Injuries or Pain.
When it comes to managing an acute injury/pain many patients may
be aware of the RICE or PRICE method. For those who have yet
to come across this acronym it stand
for Protect Rest Ice Compression Elevation.
This process was developed to deal with the immediate phase
after a soft tissue injury, characterised by an acute inflammatory
response. The cardinal signs are as follows:Heat, Redness,
Pain and Swelling.
Research now suggests using the POLICE
method. Protect, Optimal
Loading, Ice, Compression, Elevation.
The purpose of protection is to avoid further injury to the area
by protecting the injured structures. The type of protection used
varies depending on the injured area but may include a bandage,
splint, sling, protective tape, or over-the-counter brace.
Why 'optimal loading' and not 'rest'?
Rest may be useful in the immediate short term (<48 hours),
however continued rest could cause deconditioning of the tissues,
joint stiffness, muscle weakness and tightness and reduced
proprioception (control and balance).
Optimal loading will stimulate the healing process as bone,
tendon, ligament and muscle all require some loading to stimulate
The right amount of activity can help manage swelling.
Cryotherapy is an effective, inexpensive and simple intervention
for pain management. So what specifically does ice do?
From a pain perspective numerous studies have concluded that a
person's Nerve Conduction Velocity (NVC) is significantly and
progressively reduced concomitantly with skin temperature.
Associated with the changes in NCV, are increases in Pain
Threshold and Pain Tolerance. So in a nut-shell in acute pain
states, application of ice will help to reduce your pain.
Previous other suggestions for the application of ice have been
the role of controlling inflammation. However current
research is undecided at present.
How to Apply Ice:
Current research advocates the use of crushed ice only as this
adequately cools the temperature of the area to between 10-13C
(therapeutic ranges). Length of time to reach this
therapeutic range is typically 15 minutes, however suggested icing
application is for 20 minutes as this limits the increase in
temperature. This can be repeated every 2 hours if required.
Make an Ice Pack:
Place crushed ice into a small plastic bag and then tied off at
the top. By using a small amount of ice, squeezing out all of the
air from the bag, and tying the knot at the very top, you can
produce an ice bag that can be flattened out and wrapped around an
injury, completely covering the injured area.
Ice left on an area for too long (+60 minutes) can
Contraindications to use of Ice:
- Active Deep Vein Thrombosis (DVT) or Thrombophlebitis.
- Areas near a chronic wound.
- Cold hypersensitivity e.g. Raynaud's, cryoglobulinema,
- Cold urticaria (cold allergy or hypersensitivity).
- Impaired circulation.
- Over regenerating nerves.
- Tissues affected by tuberculosis.
- Haemorrhaging tissue.
- Untreated haemorrhagic disorder.
- Areas with impaired circulation.
Precautions to use of Ice:
- People with cardiac failure.
- People with hypertension.
- Areas of impaired sensation that prevent people from giving
accurate and timely feedback.
- Infected tissues.
- Damaged or at-risk skin.
The rationale for using compression pressure is to minimise
initial tissue haemorrhage after injury however the research
If you are to apply compression to your injured area attempt to
complete this immediately after injury, with continuous use over
the first 72 hours.
How to Apply?
When applying compression you should aim for uniform pressure,
from the highest point of the limb/injury to the lowest
point. Compression can be applied through the use of elastic
Research has suggested that compression should not be combined
What it could do?
The theory for using elevation after injury is to try to restore
the pressure gradients within the affected tissue. Elevating
an acutely injured joint could decrease the gravitational force
exerted on the column of blood between the heart and limb. With the
possible result being decreased hydrostatic pressure within the
vasculature, minimising swelling and the resistance to venous and
lymphatic flow around the injured tissue.
How to Elevate.
Despite clear rationale, the optimal duration or angle of
elevation remains contentious. However if you choose to
elevate your limb try to complete this as long as can be
It is also important to know that some research suggests that
after elevation the limb volumes return to their original
measurements after 5 minutes, on return to a gravity dependent
position e.g. Ankle - sitting with foot on the floor.
Clinically, a graduated return to standing after elevation is
perhaps most likely to minimise rebound swelling and
So why Elevate?
Well during the period of elevation is perhaps an opportunity
for you to gently move the injured/painful tissues more easily
which if repeated frequently could reduce localised stiffness.
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