We Should Have Gone to POLICE Long Ago!

We Should Have Gone to POLICE Long Ago!

We should have gone to POLICE long ago!

We all know and quote the acronym RICE for injury first aid. Rest, Ice, Compression and Elevation has long been used as the preferred treatment for nearly all acute injuries. There has been some debate regarding the use of ice and I explain my thoughts on this in a separate blog (link here please Katrina). In summary the blog poses an alternative view concerning ice being thought of as the panacea for all injuries. A short summary of this section of the blog is below;-:

Ice is definitely worth using for a severe injury where something has been traumatised, torn or ruptured and there is significant bleeding and swelling. Ice though may not be useful for minor bumps, bruises and low grade strains. Compression and Elevation are useful physical measures at decreasing swelling which paradoxically can increase blood flow to the area. This combination can decrease pain, increase comfort and possibly accelerate healing.

The reason that we should abandon the RICE acronym is because of the letter R and what it stands for. Rest is fine for very short periods of time but the body does not respond well to rest. There are very few conditions where complete rest rather than active rehabilitation is preferred. Early stages of a broken weight bearing bone is an example of an injury that does require rest. Most other injuries though do not. Too much rest can delay recovery and even cause other secondary injuries e.g. complex regional pain syndrome and fear avoidance behaviours, which can increase the likelihood of chronic pain and difficulty returning to work or sport.

If you sprain your ankle you will be in a situation where you can either walk or not walk due to pain. If you are able to walk with the ankle sprain then there is no reason not to. If it is too painful to walk on, you will need crutches and have an examination to ensure that there is no injury to the syndesmosis (high ankle sprain above the ankle joint) or a broken bone. If there is no syndesmotic injury or a broken bone (regardless some bone breaks are still safe to walk on) you should still try and walk. At that point what is usually the best strategy is to start touch weight bearing and progressively partial weight bear increasing to full weight bearing over several days. What this means is that you just touch your foot on the ground initially and as you start to feel better put more and more weight through the foot until you are putting all of your weight on it.

Back pain is probably the best example of why rest needs to be abandoned.

40 years ago if you injured your back you were treated with bed rest in an attempt to help alleviate the pain and allow healing to occur. The problem with lying in bed for a few weeks though is that you become deconditioned during the process. When you lay in bed for a month your muscles become weak and therefore the control of your movement becomes impaired. After a few weeks of laying around you may feel better but due to the deconditioning process which is a direct result of resting, you become a candidate for re-injury upon resuming activity. It is now accepted that it is better to start active rehabilitation exercises as soon as possible after an injury. There have been studies published showing that excessive rest and avoiding usual activities is one of the strongest predictors of a poor outcome.

Tendinopathy is another example. A regular conversation in my clinic concerns patients telling me that they hurt their tendon doing an activity and as a result have ceased doing it for a month or so. They felt better but on resumption of the activity the pain returned almost immediately. The problem is that tendinopathy is a degenerative condition where the tendon fibres suffer wear and tear and break down. Resting a “worn down” tendon may make it feel better but does absolutely nothing to regenerate any of the tissue. The only way to regenerate the tissue is with very specific strength training and exercise.

In summary if R needs to be abandoned what should we be using instead? Relative rest, modified activity are both terms which require little explanation and are accurate but the POLICE acronym is easy to remember and descriptive. Protect the injury first and foremost and then Optimally Load the injury to facilitate rehabilitation. Protect, Optimally Load, Ice (if it’s bad and you expect bleeding, bruising, swelling), Compress and Elevate. Time to adopt the POLICE.

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