Roxanne was going for a run just as it started snowing. These were her favorite conditions: the stillness in the air, the soft squeeze of the snow beneath her shoes, the tickle of snowflakes brushing her face. Lost in thought, she twisted her ankle as her foot slipped off a snow covered curb. As she lay sprawled out on the snowy sidewalk, she noticed her ankle was quickly growing to twice its normal size. She remembered an acronym – RICE, which meant rest and ice right? Was there anything else she was supposed to do? Maybe she had heard the acronym changed to something else? Polling social media, her friends chimed in with the following acronyms:
RICE (rest-ice-compression-elevation)
PRICE (protect-rest-ice-compression-elevation)
POLICE (protect-optimal loading-ice-compression-elevation)
Roxanne noticed the commonalities ice, compression, and elevation, but she was curious about the other additions. She took a deep dive into what would actually help her heal the quickest.
Why have there been changes in terminology?
The changes to the acronym all helped us be a little more precise about what we should do to help the body heal best.
It all started with RICE. Adding the P helped by adding protection via splinting or bracing unstable joints. But the “rest” is still a little vague. To most of us that means sit down and don’t move. That does not set your body up to heal efficiently.
That is where “Optimal Loading” comes in.
Optimal loading still allows for movement to maintain mobility. Adding pain free movement and loading will continue to promote blood flow toward and away from the injury site. Maybe that Optimal Load is walking with crutches, wearing a soft cervical collar after whiplash, or wearing a sling so your rotator cuff doesn’t have to work so hard to hold your shoulder up after surgery. Allowing for some movement and some loading brings the good nutrients in and the waste products out.
Optimal loading may be difficult to determine yourself. Scheduling an appointment with physical therapy (at ALTA Sports PT and Pilates), will help guide you through your optimal load to allow you to move as easily as possible, while letting you heal.
When should we POLICE?
During the acute phase – immediately after injury until 3-5 days post-injury. After surgery, you should be POLICE-ing with Every Breath You Take, and this period can be extended to 2 weeks or more.
One of the most common questions we get asked is, Should I Heat Or Should I Ice Now?
The two stimuli can Clash, as they affect healing in different ways. Heat will bring blood flow to the area while ice will decrease blood flow.
The easiest answer is “whatever you feel the best with”. If you try heating an acute ankle sprain, it won’t feel good as more blood may be brought to the injury site and increase swelling. Icing your back during a “muscle spasm” may help numb the pain, but the decrease in blood flow can make it feel more stiff afterwards.
A more scientific answer:
Ice will be your best pain reliever after an injury. Better than Advil or your favorite NSAID. Better than opiates.
(maybe not better than Valium in one of Ross’ specific cases…)
Ice will slow down the nerve impulses to your brain. Fewer impulses = less sensation = less pain.
How deep does that go?
Not deep. Maybe an inch. Maybe two. Ice really only works on superficial joints that aren’t surrounded by muscles.
Muscle stiffness often likes heat better. Chronic pain (which usually has a brain component) will respond better to a soothing stimulus like heat. If you don’t tolerate cold (also a potential sign of chronic pain), use heat. Heat is the preferred treatment for those with back pain, as those joints are buried under 40-50mm of muscle and adipose tissue in the low back and neck.
Does ice reduce swelling?
Ice will NOT reduce swelling.
Ice reducing swelling is one of the most common misconceptions in tissue healing. It does limit blood flow TO the injury by contracting the arteries, so it can help PREVENT swelling as the swelling is happening. Ice also limits the blood flow AWAY from the injury by constricting the veins. Thus, a reduction in swelling after a body part is already swollen won’t occur from ice alone. Any reduction in swelling comes from elevation and movement.
Elevation and movement will decrease swelling.
To actually increase the venous return in any circumstances, you need muscle contractions to squeeze around the veins and push the fluid through. If you elevate a limb and contract your muscles, the actions work together to reduce swelling even more.
Ball rolls are our all-time favorite exercise after an acute knee or ankle injury. They achieve elevation, muscle movement, and even a little hip and core stability by using the unstable ball.
Why is it that Swelling Occurs Anyway? Doesn’t that impede healing?
In a way, yes, the stagnation of fluids does limit blood flow, delivery of healing nutrients, and removal of waste products. But without our advances in medical knowhow, swelling would help you heal in the wild.
After a ligament tear, you lose stability in the affected joint. The swelling process fills up any available space with fluid, serving two purposes:
- It provides Stability to the joint by tensioning all of the joint’s surrounding tissue. This allows the ligament to heal by distributing the forces to other tissues around the injury and prevents continuous stress on the injured area.
- It adds Protection, by making everything more painful. You will become less willing to stress any of the injured tissue if there is a heightened sense of pain.
If you can protect and stabilize the injury without swelling (use of a brace or splint), healing can be expedited by minimizing swelling.
Moral of the story:
Don’t let swelling become The King of Pain.
Protect: to limit further injury
Optimal Load: to maintain joint mobility and overall function and fitness
Ice: for pain relief and to prevent swelling from worsening
Compression and Elevation: to decrease swelling
Then Schedule with ALTA Sports PT and Pilates in Boulder, CO by texting us at 303-444-8707
Early Physical Therapy can guide you through the POLICE Process, help you tune into your optimal load to help you heal, and get you back to your sport or job sooner.