Showing posts with label RICE. Show all posts
Showing posts with label RICE. Show all posts

Thursday, 29 May 2014

Why Proper Injury Management is Important

I recently treated a young dancer who hurt her leg at school.  The story of how she hurt her leg and her subsequent recovery is a perfect example as to why safety recognition and proper injury management is key. 

Now her mechanism of injury is somewhat amusing but totally preventable.  While at school she slipped on a pencil and awkwardly caught her balance.  She was unable to extend her leg fully and was walking around on her tippy toes when I saw her.  She complained of pain in her upper calf.  She had no swelling or deformity.  Her hamstring and calf were in spasm which was causing her pain.  I sent her home with instructions to RICE (rest, ice, compress & elevate).  This is where the story turns ugly.  She went to school the next day feeling better, that was until she was not allowed to ice during recesses and lunch.  When her mother arrived home, her ankle was swollen, bruised and sore.  She was in so much pain, you could not touch her leg without her crying.  Click here to see her ankle.  After one day of ice, elevation and rest the swelling had gone down and by day five full range of motion had returned and she is back to dance.
  
Her injury was totally preventable, making sure that things are not left on the floor and encouraging kids to be aware of their surroundings.  However, kids will be kids and that can't always happen.  What could have happened is the proper management post injury.  As was seen by her recovery once the RICE principle was initiated, if this had been done the day after injury then the swelling, pain and bruising would not have been so severe. 

Basic injury management principles are just that basic and simple.  The RICE principle has been around for many years and does not require much advanced knowledge of injury management.  Correct management obviously creates a more ideal situation for healing, which is in the best interest for everyone.  A similar situation is a friend of mine who hurt her knee during soccer.  Her husband told her to heat it that night.  These two situations show the importance of more education on basic injury management.  

As health professionals we may feel that everyone knows how to deal with acute injuries, but everyday athletes both young and old are getting improper advice which in turn prolongs their injury and taking them away from being active and achieving success. 

For more information on injury prevention and management follow us on Twitter @EliteInjuryMgmt and check out our website www.eliteinjury.com 

Thursday, 9 January 2014

Why Ice?

As you can gather from the name of this blog, I fully believe in icing injuries.  Any athlete or patient will tell you that I don't believe in heat only ice when it comes to treatment of musculoskeletal injuries.  There has been a lot of new information coming out saying that icing an acute injury is detrimental to healing.

When dealing with an acute injury the use of cryotherapy (application of cold) to the area is important for the first 24-48 hours.  The use of ice decreases pain and muscle spasm as well as blood flow, inflammation and edema.  This is due to the stop of tissue hypoxia and additional tissue injury.  When managing an acute injury the reduction of all of these aids in recovery and rehabilitation.

Reviews of research done on cryotherapy shows that more detailed studies need to be completed.  The research has proven that the application of ice on acute injuries does decrease pain, which will decrease spasm caused by the pain-spasm cycle.  Since muscle spasm decreases range of motion, this decrease in pain will lead to earlier improvement in range of motion and subsequent earlier start to rehabilitation.

The principle of RICE is still the standard when dealing with acute injuries.  Rest, ice, compress and elevate the injured area for the first 24-48 hours.  When icing on average for topical application the ice should be applied for around 20 minutes depending upon the size of the area needing treatment and the depth of soft tissue.  Topical application will reduce tissue temperature to a depth between 2 - 4 cm.

When applying ice, no matter the mode there are 4 sensations that you will experience.  Starting with cold, progressing to burning, achy/dull and finally numb.  When determining how often to apply the ice, the area needs to come back to normal body temperature before reapplying.

No matter the type of soft tissue injury, be it sprain, strain, contusion or post operative the application of ice is the still the best way to decrease pain and inflammation without the use of medications after an acute injury.

Articles used
Hubbard, T.J & Denegar, C.R. Does Cryotherapy Improve Outcomes with Soft Tissue Injury? Journal of Athletic Training. 2004 Jul-Sep; 39(3): 278-279
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC522152/

Nadler, S.F, Weingand, K, Kruse, R.J. The Physiologic Basis and Clinical Applications of Cryotherapy and Thermotherapy for the Pain Practitioner Pain Physician.  2004;7:395-399, ISSN 1533-3159
http://www.painphysicianjournal.com/2004/july/2004;7;395-399.pdf