Modified Wesley Fryer's picture

Modified Wesley Fryer’s picture

This is my third blog post about acronyms. I really like acronyms and I am getting a bit confused at the same time. Why? I quite enjoy reading about this stuff because I find it very interesting, but the fact that there is not much evidence about these subjects annoys me a bit. I would like to be able to state firmly something instead of using all the time “modal auxiliary verbs” (“might”, “may” and so on). I would like to be sure that what I am doing is the right thing, but no, it doesn’t work like that. Many papers, many studies, a lot of research and it is still inconclusive, grrrrr!!

Ok, time to talk about another well-known acronym which says, more or less, “avoid the opposite of what POLICE is about (protection, optimal loading, ice, compression and elevation)”.

And here you have it: HARM. Notice that this acronym tells you the things you should AVOID in the first 72 hours after injury.

What does HARM stand for?

H for heat:

As I said in a previous post, if you want to reduce swelling and pain, ice should be your choice and you should avoid heat. Heat increases blood flow and, therefore, bleeding and swelling.

A for alcohol:

As with heat, alcohol increases blood flow and, thus increases swelling. Also, it can mask pain and this could lead to aggravation of the injury.

R for re-injury or running:

You have to avoid any kind of exercise or movement which could worsen the injury. Be sensible and don’t try to do more than you should if you don’t want to end up needing a long period of rest.

M for massage:

Again for the same reason, massage is thought to increase swelling. This refers to the injured area, but I highly recommend massaging the surrounding areas. Massage could help to reduce muscle spasm as a result of the injury and to reduce excessive swelling.

If you are Finnish and you are reading this post, you might not like it. Why? Because if you have an acute injury, you have to forget about going to the sauna with a beer and, later on, running to the snow. It might cause you “harm” (although, the snow might be good as an analgesic). Now, I have a question for you: “is reducing swelling the right thing to do?” Most health professionals think so, but some think the opposite. Some professionals state that swelling is a process your body uses to heal injuries and that we shouldn’t stop it, but stimulate it. That’s why another acronym is used, although it is not as well-known as the others, and it is food for thought. And the type of food is MEAT (movement, exercise, analgesics and treatment).

So, if health professionals who defend the fact that we should stimulate swelling are right, HARM wouldn’t make much sense, nor RICE, PRICE and POLICE.

The reality is that this is still unclear and you might read in some papers: “Do what works for you”. This is also my advice.

Notice that POLICE and HARM are still the most popular protocols among health professionals and athletes. We´ll see whether it changes or not in some years time.

Follow this link ¿No HARM?, in case you would like to read this blog post in Spanish.

Please feel free to leave comments. I appreciate your help, as it will make this blog better.

If you have any questions, do not hesitate to contact me on The Physical TherapyPhysiotherapy Clinic based in  the University of Southampton.

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6 Responses to No HARM?

  1. Jan Zika says:

    So what IS the argument for reducing swellin(Other than its uncomfortable)

  2. ThePhysicalTherapy says:

    Hi Jan, if we talk about acute muscle injuries it is due to risk of getting compartment syndrome. Compartment syndrome occurs when pressure increases in a muscle compartment, which is a space that contents muscles, nerves and blood vessels. This compartment is covered by fascia whose role is to keep the tissues in place. Because the fascia does not stretch, when swelling or bleeding occurs, this can cause increased pressure on the capillaries, nerves, and muscles in the compartment, decreasing blood flow, which prevents nourishment and oxygen from reaching the area. This vicious cycle can lead to permanent muscle, nerve or circulation damage.
    With ligaments and tendons it is different, their blood flow is poor and there is not risk of compartment syndrome, so that´s why there is controversy about whether we should reduce swelling when having ligament or tendon acute injuries. Some people say that we should avoid excessive swelling which could be detrimental for the healing process and others say that reducing swelling means reduce blood flow which would be also bad for healing. This doesn´t happen to muscles because their blood flow is pretty good.

    I hope my respond helps you to understand this subject a bit better. Next week I will post something about this which could make things a bit clearer.
    Thanks for your comment!!

  3. Nelson says:

    Great information, thank you!

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