Updated: Mar 2
We’re often asked by athletes about what to do when injury hits – do I use heat or do I use ice? How long should I have the ice on for? Should I stretch it out or let it rest?
There’s a lot of confusion as to how to look after an injury in the early stages – which isn’t helped by the ever-growing number of acronyms out there summarising the steps. So we wanted to make things simpler – and give you a straight-forward guide as to the best ‘first-aid’ steps when looking after an acute injury.
Firstly, what are we trying to achieve in the early stages of looking after an injury?
Ideally we’d like to wind back the clock and stop the injury happening, but unfortunately what’s done is done!
What we are doing now in the early stages is trying to protect the injured tissue and prevent further damage, and limit the extent of bleeding, swelling and scarring.
Protect the injury – rest initially, but not for too long!
This is to avoid making things worse, as the injured tissue can’t cope with much in the early stages. This is just for the first 48-72 hours though, when most inflammation occurs – longer periods of rest aren’t helpful; indeed, getting moving again is the things that helps the injured tissue repair & regenerate, and get it back up to the strength we need it to be.
This is where physio is really helpful after injury, as a physio can help determine what’s still ok to be doing, and what you should be steering clear of initially. This is the concept of ‘Optimal Leading’, and it’s all about balance: doing too little and doing too much can be as bad as each other, but finding a happy medium that’s “just right” is the ideal!
There has been some debate more recently as to whether we should or shouldn’t be using ice in acute injury – however the bulk of the evidence still indicates that ice is a good strategy not only to help with pain relief, but also to control bleeding & swelling, and limit secondary tissue damage.
As a guide, I recommend to people to use ice for 10-15 minutes at a time, repeated every 1-2 hours – this way, we’re using ice often to help limit bleeding & swelling, but without longer treatment times that risk things like ice burns.
We use compression for the same reason we use ice – to limit bleeding and swelling. The great part about compression is that it’s simple, and requires little effort – whether it’s using a compression bandage or putting on your compression tights, you’re doing something to help.
Above all else, do no HARM to the injury in the first 48-72 hours!
This is one acronym that hasn’t changed over the years – and if you’ve done an injury, you need to be avoiding Heat, Alcohol, Running (or other vigorous activity) and Massage in the first 48-72 hours.
All of these things will exacerbate bleeding and swelling, along with damage to the soft tissue fibres – remember: our goal in the early stages is to limit the damage.
What about anti-inflammatories?
Anti-inflammatories are commonly used by athletes of all levels, but their use is controversial: we need to ask whether we actually need them – and whether there are any negative effects to having them.
The first thing to understand when talking about anti-inflammatories is that inflammation actually helps the healing process: it is necessary, and does a lot of useful things. So whilst we may want to limit or control it, we don’t want to stop it altogether – which is why ice may be more appropriate to limit it, rather than jumping to anti-inflammatories as a first step. There may be times when we do need to use them, but for most cases, we shouldn’t just reach for an anti-inflammatory!
Bear in mind that here we’ve only been talking about the early, or ‘1st stage’ management here: the first 48-72 hours. In this stage, we definitely don’t want you doing any stretches or other rehab exercises, but after a couple of days, when the bulk of the inflammation has settled, this is when we start people doing rehab (The ‘2nd stage’) – and this is where it’s really important to get in touch with a physiotherapist to help get moving safely and plan your rehab, so you can get back to your running as soon and as safely as possible!
1. Bleakley, et al. (2012). PRICE needs updating, should we call the POLICE? British Journal of Sports Medicine, 46(4), 220-221.
2. Orchard, et al. (2008). The early management of muscle strains in the elite athlete: best practice in a world with a limited evidence basis. British Journal of Sports Medicine, 42(3), 158-159.
3. Hill, et al. (2014). Compression garments and recovery from exercise-induced muscle damage: a meta-analysis. British Journal of Sports Medicine, 48(18), 1340-1346.
4. Paoloni, et al. (2009). Non-steroidal anti-inflammatory drugs in sports medicine: guidelines for practical but sensible use. British Journal of Sports Medicine, 43(11), 863-865.
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