When an acute injury treatment is performed, it is vital how quick treatment is put in place towards the injured. The most important in acute injury treatment, is how the injury is assessed. And whether the injured receives the right treatment. e.g use of ice-treatment in the acute phase, could in a worst case scenario, double the injury recovering time. Below is listed a series of tools and guidelines for assessment and treatment. They will help you through the three phases- Acute, sub-acute and chronically.
Acute phase for 0-48 hour period
If correctly completed from the second the injury occurs, this phase could best case scenario, halve the time of recovering from injury. It’s vital acute injury treatment is completed in 48 hours. Even if the treatment doesn’t take place until 8-hours post-injury. In conclusion acute injury treatment can be started within 48 hours and has a 48 hour duration of treatment. If acute injury treatment is put in place 46 hours post-injury, the acute phase will last 46+48 hours. The immediate help to be performed in acute injury, should be considerate of the particular situation and occurrence. The help however, should be in the nature of the PER (Only performed by educated or licensed therapeuts) or MCE methods. The treatment is to be assessed ongoingly. If there is any doubt of the extent of the injury and method of treatment, one should be conservative in one’s approach and treatment. If you have any doubts, contact accident and emergency, a practitioner or your own doctor.
The MCE method
Mobilisation – Compression – Elevation
- M = Flex the area/joint as much as possible without overexertion, to remove waste toxins, and regain nutrients to the area. This can be done by making circular movements, pumping exercises and other movement exercises.
- C = Apply a compressioning bandage, to reduce the swelling. REMEMBER not to tighten the bandage too much. One could possibly loosen the bandage 2-4 throughout the day, and apply a new.
- E = Avoid overexertion within the first 48 hours. Keep your leg elevated high, so the waste toxins can exit the injured area with ease.
- DO NOT USE ICE! ice increases the healing process, read more in the bottom of the page.
Sub-acute phase 2-100 days
In this phase it’s crucial that the injury is treated and rehabilitated correctly. It can otherwise develop into a longer lasting injury, where the body starts to adapt into a wrong pattern. Because without adopting focus into the rehabilitation and treatment, the body has to compensate for the damage done.
Worst case, the injury can become chronic, with changes in the tissue (tendons, ligaments, muscles and more) as a following of the untreated injury. Therefore acute injury treatment will in this phase, be focused around helping the injured onwards. Down below is a checklist, with a number significant points on how to handle the sub-acute phase. And which will assist you in helping the injured person.
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- 1. Assess whether the injury has occurred due to a deeper lying cause. (crooked pelvis, crooked back, balance issues in mobility and stability, legs of uneven lengths, etc.) Has the same injury e.g been there previously, or has there been a similar injury elsewhere in the body recently? If there is suspicion of a deeper lying cause, the injured should be passed on to an expert in musculoskeletal injuries.
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- 2. If the assessment is that the injury occured acutely and therefore doesn’t have a deeper lying cause, a detailed rehabilitation course should be started.
View concrete rehabilitation here
And follow the instructed guidelines for sub-acute treatment and rehabilitation.
The chronic phase >100 days
If the injured did end up with chronic damage, involuntary or not. Your focus as an acute injury therapist should be the same as the sub-acute phase. You should however be aware that rehabilitation, and eventually the treatment, could take longer. Because the tissue (tendons, ligaments, muscles, etc.) around the damaged area among other areas of the body has changed. That’s why no matter the injury, it’s recommended to see an expert in musculoskeletal injuries.
The ice-package-era is over! – MCE, new guidance for acute injury treatment!
Since 1978, when Dr. Gabe Mirkin invented the term RICE, Rest, Ice, Compression & Elevation has been the golden standard for treating acute injury. But now that time is over, when a series of studies shows cold-therapy, can actually slow down the healing process. and shouldn’t be the first choice for treatment of injury. Even the inventor of RICE Dr. Mirkin agrees.
A research published in The Journal of Strength And Conditioning Research, researched the influence of ice on muscle damages. Data from the research showed, and it shouldn’t be the first choice for treatment of injury.
All athletes, coaches, practitioners, doctors and Emergency rooms/Accident & Emergency rooms use RICE. The reason they use it, is because it supposedly relieves pain, swelling & inflammation that is considered bad. But newest research shows inflammation is the body’s first physical response to repairing tissue. That is why this inflammatory process is especially important.
Ice makes the blood vessels around the injury so subtract, and reduces blood flow. This hinders specific inflammatory cells, also called macrophage, that are designed to release a hormone known as an insulin-like growth factor (IGF-1). IGF is a primary mediator of growth hormones, and a stimulator of cell growth and proliferation(cell division). Ice appliances inhibit release of IGF-1 in the injured area. Which is necessary for recovery, and therefore the healing is slowed down.
This was shown in a research from Cleveland Clinic published in the Federation of American Societies for Experimental Biology i november 2010. The lymphatic system will of course remove the swelling, when the healing is complete.
Inflammation is the same biological process that is applied to kill bacteria in case of disease or infection. If bacteria enters the body, the immune system activates and sends proteins and cells to the infected area, to kill the bacteria. When a muscle is damaged, the immune system sends the same cells to the area, to speed up the healing in the damaged tissue.
The blood vessels don’t open for hours after the ice is applied.
Reduced blood flow can also cause death tissue and even result in permanent nerve damage.
Dr. Mirkin, who wrote The Sports Medicine book in 1978 and invented the acronym and term RICE, has urged to stop applying the RICE method, and not to stay completely inactive, because total rest also hinders tissue repair. He recommends to slightly exercise as a for3m of stimulant repair to expand the blood vessels.
Mirkin says it’s okay to apply ice as a pain relief, immediately after the injury occurs. But only in short periods. He suggests ice for a maximum of 10 minutes(Cryo-therapy) and only to reduce pain.
According to The American Journal of Sports Medicine in May 2004, shows that exercise can be a great help in the healing of ankle sprains.
So to summarize ANYTHING that reduces inflammation will prolong the healing that means both RICE-treatment and NSAID medications can slow down the healing, including anything that slows down the inflammatory process.
New keyphrase: MCE replaces the old standard RICE. and replaces ice, as an injury treatment. MCE = Move (move what you can and as much as you can) C for compression (compressing bandages) and E for elevate (keep the damages tissue elevated high).
Written by
Jan Lasota
Sportsphysiologist and Osteopath
Sources:
American Journal of Sports Medicine, January, 2004; 32 (1) : 251-261
Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999
J of App Phys. February 1, 2011 vol. 110 no. 2 382-388
Federation of American Societies for Experimental Biology, November 2010
Knee Surg Sports Traumatol Arthrosc, published online Feb 23, 2014
Editor in Chief of The Physician and Sports Medicine Journal (Dr. Nick DiNubile)
Meeusen, R. The use of Cryotherapy in Sports Injuries. Sports Medicine. Vol. 3. pp. 398-414, 1986.
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