By Athlete's Care on September 05, 2012
By Dr. Chris Klachan, DC at Athlete’s Care at The Yorkville Club
Whether you are trying to manage an acute muscle strain going into your gold medal Beach Volleyball match or sprained your ankle jumping off the Bosu ball in exercise class, your goals will likely be the same.
The most recommended protocol for self-management of acute soft tissue injury is the R.I.C.E strategy, recommending Rest, Ice, Compression and Elevation. Other medical specialists recommend adding Protection to this protocol for P.R.I.C.E. This protocol is often recommended for the first 24 to 72 hours while the body is employing the inflammatory portion of the repair cycle to heal itself. In recent years there has been considerable debate as to whether ice or heat, immobilization or gentle movement are the best course of action.
In the event you suffer a sprain or strain, err on the side of caution and use it prudently. With muscle strains, do not stretch the strained muscle as the scar is starting to form within the first 24-48 hours, and stretching can actually prolong the healing phase.
Depending on the severity, gentle muscle activation with varying range of motion beyond 24 hours can facilitate drainage of swelling and improve the quality of the healing tissue. Early motion can also work to get the bodies movement sense receptors back on board. Motion should be performed with very little resistance initially and within a near pain free range of motion.
Traditional athletic taping or Kinesiotaping performed by a therapist can also assist return to activity and/or improved function. With more significant sprains and strains bracing and/or casting may be required.
Self-explanatory really, don’t do anything that you don’t need to. While resting, attempt to find a position of relief.
In the world of managing acute injuries, the greatest debate is to ice or heat. Ice has been shown to decrease the ‘perceived pain’ of the injury by ‘numbing’ the sensory nerves relaying the message from the injury. Ice will also cause constriction of blood vessels reducing blood flow where applied. This may be beneficial as the bodies initial response is to send an exaggerated level of blood flow to the injured area. Beyond the initial inflammatory phase application of ice may impair the flow of nutrients, hormones and oxygen required for healing. Furthermore, ice may compromise the drainage of fluids once swelling has set in. Heat has also been shown to decrease pain perception to a degree and improve lymphatic drainage to decrease swelling. Heat may also cause the local blood vessels to dilate, improving delivery of the healing elements in the repair and remodel phase of tissue repair.
The most effective way to ice is with full immersion of the injured area in an ice bath (significant ice and water) for 10 minutes, followed by 10 minutes out and 10 minutes in. If the immersion is a little too much to handle, wetted ice (in a bag with water) also effectively decreases the tissue temperature. The process can be repeated every 2 hours within the first 6 to 24 hours.
Heat can be applied with a hot water bottle, heat pack or with full immersion. In addition to helping with local blood flow and lymphatic drainage, heat can relax local muscles in spasm, which is both good and bad as it can give a false sense of confidence. Some therapists will utilize a contrast method, alternating heat and ice within the acute period.
Various compression clothing and tensors can be utilized to compress the injured area. With serious sprains, an AirCast is inflatable, allowing it to conform to the joint and provide further protection.
The idea with elevation is simple. Get the injured area above the heart to reduce the exaggerated flow of fluid there and improve the return of fluid to the heart.
Overall, proper management in the early days of a soft tissue injury can make your life a little more comfortable. Perhaps more important, with this approach, one can minimize prolonged loss of function and get back to activity sooner. If you suspect your strain or sprain is of the more serious variety, do get it evaluated.
Aside from having had to apply the PRICE principles numerous times as a consequence of sporting activities gone awry, Dr. Chris Klachan focuses on sports injuries as a chiropractor administering soft tissue techniques, kinesiotaping and acupuncture at Athletes Care at The Yorkville Club.