26 Jul R.I.C.E Stopped By P.O.L.I.C.E
One of the best known acronyms in sports medicine is RICE. It has long been the stock standard advice given to anyone who has suffered an acute (new) injury, standing for Rest Ice Compression Elevation.
But studies prove that total rest is rarely, if ever, the correct management for an injury and the acronym no longer reflects best practise. There is now a new acronym taking over, longer and tougher than it’s predecessor.
The first rule of medicine has always been “Do no Harm” but we need to look at what constitutes actual harm in managing acute injuries. We have to balance this rule with the knowledge that encouraging absolute rest develops fear avoidance behaviours and non-use creates stiffness and weakness to the injured area, consequently causing harm to the patient.
Instead of the R in rest, we first need to ‘Protect’ the injury, making sure it is adequately supported and stabilised so it won’t be injured further. This can be achieved using a sling, brace, taping or splints.
Then we need to ‘Optimally Load’ the injured body part. Our job as physiotherapists is to find the correct level of loading. This might be a short period of complete rest, but more commonly our task is to find the right level of optimal loading (OL) that will challenge the joint, muscle and bone sufficiently to reduce the secondary weakness and stiffness as much as possible.
Of course the level of loading needs to be weighed carefully with the specific injury and the patient’s individual profile. Some injuries do require complete rest and some patients are more likely to do too much too soon.
It is therefore crucial to educate the patient and decatastrophize the injury. Much of our work lies in preventing the patient from developing habits of over-protecting the injured body part and moving in un-natural motor patterns. Often our patients and their families assume we will prescribe less activity, when the reality is good physiotherapists will commonly find themselves encouraging patients to do more than they would like.
So once we have ‘Protected’ and ‘Optimally Loaded’ the injury we can introduce elements of rICE, using ‘Ice’ ‘Compression’ and ‘Elevation’ to reduce swelling and inflammation.
All of our Asia Physio clinics have state of the art facilities to deliver best treatments and excellent results.
We use the Game Ready machine for ice and compression and all of our treatment tables can elevate the injured limb above the heart.
So there it is, time to ditch the RICE and bring in the POLICE – bacon is much better for you than carbs anyway right?