Ever experienced an injury that stopped you participating? Ever thought about how that feels, and wondered what you can do to prevent it happening or to deal with it as quickly and effectively as possible?
Many of you reading this will have seen a physio before, possibly for something work-related or sport related, or just bad-luck-that’s-life related! So we thought we might have a bit of a chat about what happens when you get injured and how we physios can play a role in treating and, ideally, preventing injury wherever possible.
WHAT HAPPENS WHEN YOU GET INJURED?
Let’s keep this to simple soft tissue injuries. That includes muscle tears, tendon injuries, ligament sprains, bruises, even disc bulges (although we might look at that last one separately). And we’ll keep the focus today on acute soft tissue injuries – chronic injuries tend to be managed differently.
Check out the diagram below for an idea about what happens to you when you strain, sprain or tear something, from the moment it happens to what should be complete resolution of your problem.
Many of you reading this will have seen a physio before, possibly for something work-related or sport related, or just bad-luck-that’s-life related! So we thought we might have a bit of a chat about what happens when you get injured and how we physios can play a role in treating and, ideally, preventing injury wherever possible.
WHAT HAPPENS WHEN YOU GET INJURED?
Let’s keep this to simple soft tissue injuries. That includes muscle tears, tendon injuries, ligament sprains, bruises, even disc bulges (although we might look at that last one separately). And we’ll keep the focus today on acute soft tissue injuries – chronic injuries tend to be managed differently.
Check out the diagram below for an idea about what happens to you when you strain, sprain or tear something, from the moment it happens to what should be complete resolution of your problem.
Soft Tissue Injury Repair Process
What you will notice is that pain generally increases over the first day or so – associated with swelling and the release of inflammatory agents from damaged tissues – then it tapers off, sometimes quickly sometimes not so quickly.
HOW TO BEST MANAGE THE FIRST FEW DAYS
Most people are familiar with the good old RICE acronym (Rest, Ice, Compression, Elevation). Sometimes this is extended to include a P for Prevention or Protection and sometimes finished off with a D for Diagnosis – that is, have it looked at by a professional.
It might surprise you to know that this acronym has been questioned, especially with regard to Rest and Ice.
“So, you are saying Don’t ice an acute injury?”
That is correct. Icing an injured area for 10min every hour or so may help to control pain by cooling the skin, but not enough to actually chill the damaged tissues underneath. Keeping a cold-pack on long enough to cool the deeper tissues would probably damage the superficial tissues, and would probably be counterproductive to the healing process, as icing probably actually slows healing down by slowing the normal and healthy process of inflammation.
The idea that icing prevents swelling is likely achieved just as effectively by compression and elevation. Yes, cold makes blood vessels constrict, at least temporarily (in fact prolonged exposure to cold can have the opposite effect) – but this will also slow the influx of cells coming to assist with repair, and slow the body’s ability to drain extra fluids away from the area.
“What about Rest?”
Well, relative rest might be more appropriate. Lay off activities that will exacerbate the injury but staying completely still or avoiding using or putting a degree of weight through injured body parts, could also set healing back.
Generally, early mobilisation – that is, moving the body part, usually non-weight-bearing – gets a better rate of recovery than immobilizing the body part. And getting that body part moving after the acute phase is much easier than if it is allowed to stiffen by being completely immobilized.
The decision to immobilize or to gently move is one best made by a professional. Generally, only severe injuries need to be immobilized.
“Should I take anti-inflammatories?”
Our advice is take paracetamol for pain as your first option. Anti-inflammatories (or non-steroidal anti-inflammatory drugs, NSAIDs) will likely interfere with the process of healing via the natural inflammatory process. In severe cases, where swelling is causing other problems, like impingement on nerves, we reckon NSAIDs may be necessary, to allow relatively normal movement or sleep, which are important to recovery and safety. But generally see if you can get by without them to start with.
SO WHAT’S OUR NEW ACRONYM IF R.I.C.E. IS OUT?
PEACE seems to be a good one that is based on evidence and moves beyond “what we’ve always done”. The below image is a nice summary:
(Image from therunningclinic.com)
DON’T NEGLECT YOUR MEDIUM TO LONG TERM RECOVERY
Something a lot of people don’t appreciate is that the job is not done when you are out of pain, and that rushing back into full-scale activity can actually set you back to square one, or worse: bring on a more severe injury.
If you want to get back to full speed sport, but you need to have regained resilience and extra reserve if you want to avoid re-injury.
And that’s what we’ll talk about next time… We’ll talk about how PEACE can be followed up with LOVE…!
HOW TO BEST MANAGE THE FIRST FEW DAYS
Most people are familiar with the good old RICE acronym (Rest, Ice, Compression, Elevation). Sometimes this is extended to include a P for Prevention or Protection and sometimes finished off with a D for Diagnosis – that is, have it looked at by a professional.
It might surprise you to know that this acronym has been questioned, especially with regard to Rest and Ice.
“So, you are saying Don’t ice an acute injury?”
That is correct. Icing an injured area for 10min every hour or so may help to control pain by cooling the skin, but not enough to actually chill the damaged tissues underneath. Keeping a cold-pack on long enough to cool the deeper tissues would probably damage the superficial tissues, and would probably be counterproductive to the healing process, as icing probably actually slows healing down by slowing the normal and healthy process of inflammation.
The idea that icing prevents swelling is likely achieved just as effectively by compression and elevation. Yes, cold makes blood vessels constrict, at least temporarily (in fact prolonged exposure to cold can have the opposite effect) – but this will also slow the influx of cells coming to assist with repair, and slow the body’s ability to drain extra fluids away from the area.
“What about Rest?”
Well, relative rest might be more appropriate. Lay off activities that will exacerbate the injury but staying completely still or avoiding using or putting a degree of weight through injured body parts, could also set healing back.
Generally, early mobilisation – that is, moving the body part, usually non-weight-bearing – gets a better rate of recovery than immobilizing the body part. And getting that body part moving after the acute phase is much easier than if it is allowed to stiffen by being completely immobilized.
The decision to immobilize or to gently move is one best made by a professional. Generally, only severe injuries need to be immobilized.
“Should I take anti-inflammatories?”
Our advice is take paracetamol for pain as your first option. Anti-inflammatories (or non-steroidal anti-inflammatory drugs, NSAIDs) will likely interfere with the process of healing via the natural inflammatory process. In severe cases, where swelling is causing other problems, like impingement on nerves, we reckon NSAIDs may be necessary, to allow relatively normal movement or sleep, which are important to recovery and safety. But generally see if you can get by without them to start with.
SO WHAT’S OUR NEW ACRONYM IF R.I.C.E. IS OUT?
PEACE seems to be a good one that is based on evidence and moves beyond “what we’ve always done”. The below image is a nice summary:
(Image from therunningclinic.com)
DON’T NEGLECT YOUR MEDIUM TO LONG TERM RECOVERY
Something a lot of people don’t appreciate is that the job is not done when you are out of pain, and that rushing back into full-scale activity can actually set you back to square one, or worse: bring on a more severe injury.
If you want to get back to full speed sport, but you need to have regained resilience and extra reserve if you want to avoid re-injury.
And that’s what we’ll talk about next time… We’ll talk about how PEACE can be followed up with LOVE…!
If you have a fresh injury, get in touch with us and one of our Physios will be happy to see you right.
