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For decades, the basic course of treatment taken after an acute (non life/limb threatening) injury has been the R.I.C.E method, which stands for Rest-Ice-Compression-Elevation.  This pattern is very proficient at decreasing the pain and swelling of an injury. But, unfortunately, this method does very little in terms of healing and returning the impacted joint or muscle to pre-injury performance. The number one predictor for future injury, is past injury.  The recurrence of these chronic injuries shows that we need to examine and improve our protocols for initial care and rehabilitation of the injury.

Here Come the P.O.L.I.C.E.!

P.O.L.I.C.E does contain some of the elements of the original R.I.C.E protocol, such as the Ice, Compression and Elevation to manage both pain and swelling of the joint.  These are all very important steps, but should not be the only basis of our post injury care. The first step of this method, P, stands for Protection.  This simply means we need to protect the joint from further damage and allow the scar tissue to form new bridges throughout the injured tissue.  This phase also utilizes the ice, compression and elevation to manage any resultant swelling. This protection phase should last anywhere from 48-72 hours before we start to incorporate the next, and most important, phase of this care.

The New Guys: Optimal Loading

The newest addition to the protocol are the O and L letters, which stand for Optimal Loading.  There is a growing body of research showing the benefits of movement early in injury care; early movement promotes early recovery.  In a completely immobilized joint, the scar tissue lays down in a haphazard and shortened fashion, weakening the new tissue.  When the athlete returns to their sport, this new tissue cannot handle the demands of the force and range of motion being placed on it. Proper loading of the affected joint tissues early in the injury care, actually aids in the proper laying down of scar tissue, and makes the post healed tissue more resilient and adaptable.

So, What Does Post-Injury Care Look Like Then? 

Injuries can be a scary part of any sport, and knowing the correct way to handle and rehab them is essential for a long, fruitful sports career. During the first 48 hours (or 72 hours for severe injuries), the first step is to simply protect the injury from further damage by using slings, crutches, braces etc. Ice, compression, and elevation are all to be utilized during this initial time period as well to reduce pain and swelling. After the first 48 hours, movement should begin to be reintroduced. Start with simple range of motion drills to take the joint through its full range, and ensure proper tissue pliability.  Once that becomes comfortable, start with very basic body weight movements/tension exercises to begin strengthening the tissues again.  Then, move into more balance/fitness exercises, and finally sport specific exercises to get the athlete ready to return to full play.

Pay attention to how each phase affects the injured area, if there is an increase in pain/swelling during a particular phase, revert to the previous phase, and don’t be afraid to utilize the I, C, and E mentioned earlier.  Disclaimer: If there is any chance of a broken bone, severe soft tissue tear, copious bleeding, extreme pain etc., seek the appropriate sports medicine physician on how to best proceed. Injuries are part of every sport and are something that every athlete will have to deal with at some point.  Having a plan in place prior to an event helps to both handle that injury, and prevent it from becoming a recurring theme throughout the athlete’s career.