What is done in the first 24-48 hours following an athletic injury is very important and can often reduce the time of recovery by weeks. As always, if you have a significant injury you should seek medical attention immediately, but if you have a sprain or strain, the acronym P.O.L.I.C.E. can be used to help guide you in managing the immediate injury to encourage speedy recovery.
P : PROTECT THE INJURED AREA
One of the keys to recovery is to protect the injury from further damage. While prolonged immobilization has been shown to delay recovery and create complications, some short term immobilization or protection can help early. Fractures and serious ligament issues may require casting or immobilization in a boot for a few weeks to allow healing. Sprains and strains can be supported in the short term with taping, bracing or wrapping to limit some range of motion, and sometimes crutches can allow some early weight bearing. Your rehabilitation professionals can guide you in this area if you need extra advice.
OL : OPTIMAL LOADING
Optimal loading has been shown to stimulate the healing process once the initial inflammation phase has happened. In fact, bone, tendon and muscle injuries require this to facilitate healing. It is important to have the proper balance and progression of loading to facilitate recovery while not overdoing it. Optimal loading progresses the athlete through a series of supports and exercises to begin to weight bear or use the injured area safely. Crutches, braces and supports often facilitate early activity to encourage healing. Complete rest has been shown to be quite detrimental to the healing process after the first few days, unless there is an injury that must be immobilized like a bone fracture.
The right amount of activity can also help to manage oedema (chronic swelling). For example in the ankle, contraction of the calf muscles helps to move swelling up the body against gravity. Complete rest would prevent this and slow down the healing process and allow the muscles to atrophy or lose strength. This is often an area that a rehabilitation profession can guide you in the correct techniques.
I : ICE
Evidence suggests that icing the injured area for 10-15 minutes is helpful in pain management, and decreasing the immediate swelling thus managing the early inflammation process to facilitate healing. It reduces tissue metabolism and cause blood vessel constriction. This can be a regular ice pack, an instant ice pack (be careful of frost bite), or an ice bath or commercial cooling unit (IceMan, etc.). The goal is to use ice 10 minutes on and then 20 minutes off, multiple times per day for the first 48 to 72 hours. Icing for longer than 20 minutes at a time has been shown to potentially increase swelling, although occasionally we may gently cool a post surgical injury for a longer period of time with a commercial cooling unit. It is important to exercise caution if you have a circulatory issue as you may not tolerate ice well and have an increased risk of frostbite. An excellent resource for the use of ice and heat with an injury was done a few years ago by SportMed BC, and my friend Paul Dwyer who is an Athletic Therapist. The evidence has not changed since this webinar was recorded. It can be found here: https://www.youtube.com/watch?v=qV-q9N6n_Vk.
C : Compression
Compression of an injured area makes a big difference in the first 48 hours in managing swelling and limiting bleeding from the injury. In fact, research shows that swelling is significantly reduced if all you can do is provide compression and elevate the injured area if you don’t have ice available. This can be achieved with a compression bandage such as a tensor, or certain taping techniques. Bandaging should be performed from distal ( away from midline) to proximal (close to midling). An example is wrapping from your wrist to your shoulder for an elbow injury and not the other direction. If you are using a tensor make sure to remove it before bed, so you don’t cut off your circulation. Here is an example of wrapping a tensor bandage on an ankle https://www.youtube.com/watch?v=ZGFznb-5jTo
E : Elevation
Elevating the injured area allows the swelling and excess fluid to drain back into your lymphatic system and circulation. This basically involves resting with your upper limb above your heart, or your lower limb above you pelvis. Even elevating your foot on a chair while you are sitting at school is helpful in an ankle sprain.
Time matters with how an injury is managed in the early stage. Early Physiotherapy or Rehabilitation has been shown to reduce the time to recovery. Often , one or two visits with a sports rehabilitation provider can get you back in the game and provide valuable information on the recovery process.