I have talked about the RICE and PRICE protocols for acute injury management in this previous blog post. And not long ago PRICE became POLICE, as you can see on this paper by C. M. Bleakley et al. In this post I am going to explain to you what this new protocol is about and why it is thought to be better than the previous one.
This is a brief reminder of the RICE and PRICE protocols:
- Both talk about the importance of rest, ice, compression and elevation to manage acute injuries. Rest to allow the injury to heal, otherwise you will worsen your condition and it will take longer to heal. Ice, compression and elevation are used to reduce swelling and pain in different ways.
- Also, PRICE added the P for protection to insist on the fact that you need to allow your injury to heal, wearing some kind of support (aid), as for example, crutches or braces.
What POLICE protocol did was to take away the R and add OL.
Why take away the R and add OL?
Let’s start with the R. It is true that unloading is required after acute injury, but the problem is that rest should be limited to immediately after the injury, as if your period of rest is longer it might be harmful (weakness, stiffness, reduced proprioception or, in other words, the sense of position and movement, etc.)
Progressive loading is better to restore strength and morphological characteristics of the tissue. Early mobilisation and functional rehabilitation with early weight-bearing, usually with protection, are more effective than immobilisation and total rest. Check out these three papers which talk about this (Effect of accelerated rehabilitation on function after ankle sprain by Chris M. Bleakley et al, Acute treatment of inversion ankle sprains: immobilization versus functional treatment by Jones MH et al. and Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults by Gino MMJ Kerkhoffs et al.)
The difficult bit is to find the loading-unloading balance during tissue healing. Rest may be harmful and inhibits recovery and overly aggressive action (performance) could cause further damage. Protection, therefore, remains an important principle. The key is to find (and here it is) the “optimal loading“ or OL.
Optimal loading means replacing rest with a rehabilitation programme where activity encourages early recovery, as bone, tendon, ligament and muscle need loading to stimulate healing.
Optimal loading refers to any type of physical therapy intervention such as manual techniques or providing patients with crutches and supports which will help to adjust optimal loading.
Notice that optimal loading might mean on some occasions not loading at all. This is the case of really bad fractures and complete muscle or tendon ruptures which might even need surgery, and loading might be contraindicated at some point.
When are you loading too much? Well, this isn´t an easy answer. Every injury is different for every person and we all have a different pain threshold. Also, the response to loading is different for every tissue, as you can see in this study by K M Khan. So, load as much as you can manage and keep as active as you can. If you listen to your body and it is shouting at you, you are doing too much. Do as much as you can tolerate and be sensible. Remember the post on running prevention where I explained the importance of knowing your body and its limits.
Well, POLICE is the current acute injury management protocol, but I am sure that in the future I will come across another acronym and be sure that I will keep you updated.
This scheme is a summary of the two posts on Acute injury management:
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