For many injuries that do not require an immediate trip to the hospital, it can take some time to get in to your doctors. To protect a recent injury, be it jammed finger, rolled ankle, or strained back, there are some basic guidelines that have made their rounds for many years, and there are some new updates to these rules that seem to accelerate your return to life! Let’s talk about what you’ve learned before, and how new guidelines can modify this for even better return!
The Old (RICE)
Rest- avoid all load through the injury, don’t stand on a hurt ankle, put a hurt arm in a sling
Ice- apply ice for 20 minutes, leave off for 20 minutes
Compression- utilize light compression garments or wrapping to alleviate swelling
Elevation- keep swollen areas above their resting position to assist with reduction of inflammation
Will the old ways hurt me?
Absolutely not, the commonly known RICE method is still employed by many with reasonable efficacy! The differences now are that we may be able to get you better even faster!
The New (POLICE)
Positioning- after any injury, we are often tempted to let a region relax into a contracted position (after an ankle sprain, we often let the toes point down, contracting our calf and preventing normal walking). It is important to find a neutral position to rest in (for example, keeping the ankle nearer 90°) so that abnormal contractures can be avoided and more normal use patterns can be maintained! If you never lose normal movements, you don’t have to work hard to gain them back once you are healed!
Optimal Loading- we have learned that absolute rest is not necessary! In fact, light movement can actually assist in swelling reduction as it increases blood flow, and also stimulates local nerve endings to progress an injured area faster! The key is to only load within low levels of pain, estimated about 3-4/10 if 10 is the absolute worst pain imaginable. This means for an ankle sprain, for example, it is okay to walk on it! But, if this increases your pain or causes you to limp, using crutches or a cane to modify your walk and put less weight onto the ankle so that you do not need to limp and your pain is no greater than 4/10 is a good idea. Essentially: use is good! But high aggravation is not. It is safe to use your injured region, just monitor your symptoms to learn what that day allows!
Ice- much like RICE, ice can still be helpful here! The guidelines for when have changed, slightly, however. Rather than 20 on 20 off, research seems to indicate than 10 minutes of ice use is plenty to reduce inflammation, and leaving the ice off for at least an hour can actually improve circulation and reduce some reactive vascular changes to the extreme cold that might slow down full resolution. You often will find that ice is only effective for you in the acute stages, about 1-2 weeks, and it is okay to stop if you no longer notice a difference!
Compression- just as before, compression within your comfort level over a swollen area can be very helpful, and sport compression sleeves are often the most consistent way to apply even pressure to an area! No changes here!
Elevation- still just as true, elevation can cause inflammation to flow down and away from the injured region. An important detail, however, is that the joint needs to be elevated above the level of the heart. Sitting with my feet propped still places them below my heart, and does not allow complete drainage. Lying on my back with my feet or arm up, however, should! This does not have to be performed at all times, but when you must be still for long periods this is the optimal way to go!
So, no really big changes, but these little once can accelerate your return and make your life much easier! RICE still works, but it looks like POLICE can work even better!