How To Treat A Muscle or Ligament Tear

Rest, Ice Compress, Elevate. RICE has been the consistent go-to treatment technique for injuries for decades.  But recently we have seen a shift, initially, this was to POLICE. Protect, Optimal Loading, Ice, Compression, Elevation. Removing Rest and replacing it with ‘protect but load-it-gently’ (Optimal Loading) is a positive move as we continue to understand that without some ushering; repair is slower, everything stiffens up and we become deflated.

But now the rise of PEACE & LOVE not only accounts for this ‘rest isn’t best’ approach but also removes ice! Hold on, what’s that now? I hear you, ice is still used on TV, in school playgrounds, in leisure centres, pitch side…. everywhere! Correct, in some of these instances ice is used as a pain-killer. Cold reduces nerve transmission and therefore will reduce pain. It also serves to make the first aider look more effective and the patient feels like they’re being treated – never underestimate the power of just feeling cared for.

Inflammation isn’t the enemy

However, the application of ice has been shown to interfere with the normal processes of inflammation that are crucial for healing.

We have been led to believe that inflammation is bad, and yes, it contributes to pain and certainly doesn’t look great. However, the process of inflammation initiates healing and repair. Right up until you return to your activity there is a sequence of chemical & hormonally driven processes designed to repair injured tissue. Each will be more effective if the prior is completed in full.  

Weighing all this up, we must control inflammation, NOT stop it. This leads me back to PEACE & LOVE.

PEACE

Protect

Reduce movement or offload (if painful) for 1-3 days. Let pain guide the level of protection required. This may mean use of crutches to get around or a bandage to reduce your movement.

Elevate

Lift the injured area above your heart as often as possible. This will reduce fluid in the area and in turn reduce pressure & pain from fluid build-up.

Avoid Anti-inflammatory Medication

Taking ibuprofen for example to interfere with the normal processes of healing

Avoid ice – application of cold to an injury is mostly for pain relief but reducing inflammation can interfere with the normal chemical processes required to heal.

Compression

Using a bandage to apply compression can help to control fluid residing in the injured area, as well as provide support, perhaps also reducing movement temporarily whilst initial healing takes place.

Education

Seek advice on what has happened, how long healing may take (link to healing blog), a gradual loading program. Understand rest isn’t best but how you can optimise recovery.

&

LOVE

Load

Gradually adding tolerated load will optimise repair & recovery. Pain is your guide, be progressive. This might start as simple movement, exercises with bands or gradually reduced the amount you use crutches. Eventually returning to weighted activity where indicated.

Optimism

Research shows that frame of mind can impact injury recovery greater than the severity of injury itself.

Injury can often make us catastrophise, fearful and perhaps trigger depression. Remaining realistic but optimistic will optimise recovery.

Understanding your injury & the timeframe as well as a gradual rehab program can promote a feeling of control help to reduce negative emotions.

Vascularisation

Aerobic activity that is pain-free can be mood-boosting and increase blood flow to aid healing. Try a bike or swimming if impact is the issue or be creative with an activity you enjoy like using a float to reduce arm or leg action in the pool.

 Exercise

Use a rehabilitation program that focuses on restoring:

-          Mobility

-          Strength

-          Proprioception

 Pain is the guide in the early stages but as you progress through the phases of healing exercise should be challenging and focused on your goals.

Rehabilitation will also reduce recurrence.

In summary

Rest isn’t the best approach and education is more important than you think!

 References

Dubois B, Esculier J. Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine 2020;54:72-73.

 Bleakley CM, Davison G. Management of acute soft tissue injury using protection rest ice compression and elevation: recommendations from the Association of Chartered Physiotherapists in sports and exercise medicine (ACPSM)[executive summary]. Association of Chartered Physiotherapists in Sports and Exercise Medicine. 2010:1-24.

 Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE? British Journal of Sports Medicine 2012;46:220-221.

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 Singh DP, Barani Lonbani Z, Woodruff MA, Parker TJ, Steck R, Peake JM. Effects of topical icing on inflammation, angiogenesis, revascularization, and myofiber regeneration in skeletal muscle following contusion injury. Frontiers in physiology. 2017 Mar 7;8:93.

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 Briet JP, Houwert RM, Hageman MG, Hietbrink F, Ring DC, Verleisdonk EJ. Factors associated with pain intensity and physical limitations after lateral ankle sprains. Injury. 2016 Nov 1;47(11):2565-9.

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 Bleakley CM, O’Connor SR, Tully MA, Rocke LG, MacAuley DC, Bradbury I, Keegan S, McDonough SM. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. Bmj. 2010 May 10;340.

 La Clinique du Coureur. PEACE & LOVE: New acronym for the treatment of traumatic injuries. Published on 30 August 2019. Available from https://www.youtube.com/watch?v=HGTabgG7GIU (last accessed 25 June 2020)