P.R.I.C.E. is no longer the recognised first approach to treatment of any acute injury. the old acronym has been replaced with P.E.A.C.E. and L.O.V.E.
Protect –avoid massage, avoid deep heatavoid excessive activity – running, jumping etc
Elevate – place the injured area higher than the lymph nodes
In our clinic we use M.L.D. – manual lymphatic drainage to remove swelling and so facilitate healing
Avoid Anti-inflammatories –take painkillers if required but DO NOT take anti-inflammatories as every injury must go through an inflammatory process
DO NOT apply anti-inflammatory gel
ARNICA – can be applied – but DO NOT rub it in hard
Compression of the injured area will help reduce swelling. Use a stretchy bandage, or tubi- grip. Ensure that when applying compression there is more pressure on the bandage below the site of injury and that it gradually reduces as the bandage comes closer to your chest – this is to ensure that there is no tourniquet effect which would cause swelling below the site of injury, I have seen cases where swelling gathers around the knee and causes problems there when the injury was in the thigh. Never apply a non-stretchy bandage around a limb in a continuous strip as this could cause a tourniquet.
Educate –Explain the injury, stress the importance of PEACE & LOVE
Stress the importance of following physio guidelines on return to sport
Without scare-mongering outline the risks if they do not follow plan
If the physiotherapist has shown you how to do Manual Lymphatic drainage, do this as prescribed. Since we began introducing MLD to the acutely injured athlete we have observed a significant reduction in unnecessary side effects of acute injuries.
Anti-inflammatory gel can be applied to the injured area after 24 hrs. It is not advisable to apply anti-inflammatory gel or take anti-inflammatory medication within the first 24 hours after acute injury as the body’s natural response to any injury is to produce a local inflammatory reaction which is a necessary part of the healing process after any acute injury.
A chartered physiotherapist will be able to give you specific advice regarding your injury. Do not wait until the injury settles or the swelling goes down, it is only a myth that a physiotherapist can not treat you at this stage. In Kilkenny Physiotherapy and Sports Injury Clinic we believe that the earlier we see you with an acute injury the better as we can give you specific exercises and advice for your injury, strap it in the correct way, give you alternative safe activities to do while your acute injury is healing and we can help speed up your return to sport by preventing you from doing things which will ultimately delay your return to sport.
H.A.R.M. stands for Heat, achohol, running and massage and these are not recommended in the first 48 hours after any injury as they have a harmful effect as below.
Never apply heat to an injured area in the first 48 hours. There is a natural inflammatory process which must occur, after any acute injury, in order for healing to begin to take place. Heating the injured area while this process is taking place will cause increased blood flow to the area and increase the damage done.
Alcohol is harmful to any acute injury. It may cause increased bleeding in the area. Unfortunately quite often at the end of a season if a player sustains an injury in their last event of the year, they can neglect the acute injury and indulge in a few pints, it really is best not to do this as it can slow down the recovery process.
Activity on an acute injury will increase the blood supply to the area and worsen the injury. We say running with reference to a lower limb acute injury, but if it is an upper limb injury then using the arm should be avoided.
Under no circumstances should the area be massaged in the first 24 hours as this will increase the swelling and bleeding in the area. I have seen cases where a kindly “bagman” may “rub it out”, and I have seen a case where a player was rushed to hospital when his leg swelled up due to massage on an acute injury. He subsequently spent several days in hospital on a drip to stop the bleeding.
This does not include Manual Lymphatic Drainage which is only superficial and will help draw swelling away from the area.
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