Is R.I.C.E outdated for acute injuries?

We all know the acronym R.I.C.E - Rest, Ice, Compression, Elevation - often used after an acute soft tissue (muscle, tendon, ligament) injury such as an ankle sprain or pulled muscle. We know there is merit to each of these things individually with injury recovery, but as of recently, strict rest after a soft-tissue injury is being challenged in the sports medicine world. After an acute injury, brief periods of rest and unloading of the injured tissue are recommended for a limited duration to avoid further injury to the tissues and allow localized healing mechanisms to occur at the cellular level. However, studies are now showing that progressive loading of the injured tissues may be superior than R.I.C.E alone. Controlled, progressive loading of the acutely injured soft tissues can help restore tissue strength and has been shown to improve healing times when compared to strict immobilization and rest. Hence, this is where the updated acronym P.O.L.I.C.E comes into play! 

According to a recent editorial by the British Journal of Sports Medicine, P.O.L.I.C.E or Progressive Optimal Loading - Ice - Compression - Elevation, may be the best treatment guidelines to assist you in managing an acute soft tissue injury(1). Progressive optimal loading is a broad term referring to gentle, controlled forces applied to the tissues as tolerated. These forces can range from hands-on (manual) techniques applied to or near the injured tissue by your Physical Therapist to gentle range of motion or isometric muscle contractions. As the BJSM clinical commentary states, the word “optimal” will depend on multiple variables relating to the injury including nature, severity, and timing of the injury. These types of early interventions can promote recovery at the cellular levels of the injured tissues and allow them to remodel into stronger, healthier tissues. It is important to know what exercises are appropriate in the P.O.L.I.C.E model for the promotion of healing to the tissues, and that is where your Doctor of Physical Therapy at Colorado Sports Physical Therapy will guide you. Call today if you are healing from an injury and looking for ways to speed up your recovery to get back to the activities you love!

References:

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

It's Fantasy Football Time!

Yes, it is just about that time of year again and if you are like us, you are excited about the prospect of the return of FOOTBALL! With the return of the NFL, it brings the return of fantasy football. Every year, I have patients asking me about who to draft and stay away from when it comes to injuries, so I would like to share some tips.

1.       Not everyone is Adrian Peterson. In fact I am pretty sure he is an alien. The vast majority of human beings cannot fully recovery from ACL surgery in only 6 months. I remember telling a friend of mine that, in no way, should you draft him. No one could have predicted that he would return to such a level so quickly and not re-tear his ACL. Also, side note, if you are having ACL surgery, please do not ask your PT to recover as quick as AD. Most return to sport protocols are more like 9-12 months at a minimum. Just look at the case of Jake Butt, the Michigan-turned-Broncos tight end who is almost at 2 years post op, but looking great!

2.       Some injuries can truly tank fantasy points. I had a great conversation with Dr. Mark Drakos from Hospital for Special Surgery in New York, who was also a team doctor for the New York Giants, and he referred me to a very interesting 2010 study out of Duke University regarding NFL players and Achilles ruptures. Basically, it concluded that only two-thirds of players in the NFL with Achilles ruptures return to play and of those players who do, their performance was significantly affected not just in the first season back, but over the next three. How did they measure their performance? In games played and fantasy points of course! What about Michael Crabtree you ask? Well in the first years back after his 2013 injury, he was not effective at all. It took him another 3 years to be a top target for the Raiders.

3.       Concussions are not to be messed with. Are you looking at players that have a history of concussions? If you are, don’t be surprised if they end up on the sideline again this year in concussion protocols. Even with the new tackle rules, I think you are still going to see quite a few this year because tackle form can’t be corrected overnight.

4.       Beware of the MCL sprain. I like to refer to this one as the most painful minor injury you can have. Every time you see a player cut or pivot, you are seeing them put strain the Medial Collateral Ligament (MCL). While surgery is usually not needed in this recovery, it tends to be incredibly painful and lateral movements can take your breath away. If your job is to juke and cut in order to dodge tacklers, you can imagine how painful that could be. 

Obviously, every athlete recovers differently and when it is your full time job to rehab, recover, and prevent injuries, you will get better faster, but hopefully you can use one or two of these tips to avoid getting stuck on the waiver wire with no one to pick up when your star goes down. Happy drafting everyone!

When is “No Pain No Gain” Actually True?

              We all know that when you work hard for something, the results can be spectacular, however there can also be a downside to that. Who hasn’t heard the phrase “no pain, no gain”? As a young athlete, I know I must have heard it almost every day in the gym, and I continue to hear it to this day. While there is some truth to the statement, you must remember that all pain is not created equal. In fact, pain is something that has evolved with humans as a protective mechanism with our body basically telling us, “if it hurts, don’t do it”.  Here are some other helpful thoughts when dealing with pain.

1.       How much pain are you in?

This is one of the first questions your physical therapist may ask you. It seems like common sense that the more pain you are in, the worse, but there is something very important to keep in mind. Pain can be a muscle inhibitor. This means that when you are actively causing pain, your muscles most likely are going into protection mode and will not work optimally. Think about those lovely times that your sibling or friend gave you a dead leg and you immediately fell to the floor. That gives you a pretty good idea of muscle inhibition through pain.

2.       Where is your pain?

This is a big one. Pain in your joint is very different than muscle pain and really, there should never be a time that it should be happening. Do your knees hurt when you squat? Stop. Does your shoulder hurt when you throw? Stop! Most of the time, this is correctable with strength, flexibility, and education, but they should never happen! And furthermore, you should be able to do these activities relatively pain free.

3.       What kind of pain are you having?

Here is another question that most of you should have heard and it helps us make clinical decisions when it comes to your diagnosis and plan of care. Sharp, stabbing, shooting pain are all red flags for us. They can indicate acute, active injury with possible nerve involvement. If you feel this kind of pain- stop what you are doing and seek help! Pain that is more along the dull, achy side is usually more indicative of chronic conditions, but is still important to address. Don’t wait to address it, because it can be harder to get rid of the longer you wait.

4.       How long does your pain last?

Do you go for a run and your pain lasts for a week? That usually is not a great sign. Delayed onset muscle soreness, or DOMS, is the technical terminology for the soreness you have 24-72 hours following a hard workout or that first day back on the slopes. This is a normal muscle reaction that will subside with rest and gentle movements (remember that pain can actually make your muscles feel weak). Anything longer than that could indicate actual injury. A good general rule is pain that lasts for anything more than a few days should probably be checked out.

To be fair, the medicine of pain science is far more complicated than what is presented above. In fact, there are physicians that focus only on pain management. However, you can learn to be better aware of what your pain means and how to manage it when you can learn to describe it. No pain no gain should not be a definitive lifestyle, but an idea of how you can work hard to gain specific results.