Treating Acute Sports and Exercise Injuries in the First 24 to 72 Hours
Many acute sports or exercise injuries can safely be managed at home for a few days, until symptoms are relieved or until a physician can perform an in-office evaluation.
Existing medical research does not definitively support any specific treatment regimen, but most medical professionals and textbooks agree that the initial home treatment for mild and moderate injuries should be guided by the R.I.C.E. or P.R.I.C.E. protocol—Protection, Rest, Ice, Compression and Elevation. These principles have been a mainstay of acute sports and exercise injury management for decades.
This article reviews how these injuries cause symptoms, such as pain, swelling, and inflammation, and how to relieve them using the P.R.I.C.E. protocol.
When to go to the ER
Acute sports or exercise injuries generally occur as a result of a specific event, such as falling on an outstretched hand, collision with another athlete, landing awkwardly, or quick acceleration. An athlete may sustain a sprain or strain, contusion or fracture, dislocation or partial dislocation (subluxation).
While many injuries can be immediately treated at home, suspected fractures and dislocations warrant emergency medical evaluation. In the event of deformity, inability to bear weight, or worsening signs and symptoms, emergency medical evaluation is recommended. A trip to the ER is also advised if the injured person becomes notably pale, loses pulse, or experiences paralysis, tingling, or extreme pain, as these can be signs of damage to blood vessels or nerves.
Basic Science of Acute Injury
An acute injury results in damage to soft tissues, including skin, fascia, cartilage, muscle, tendon, and/or ligament tissue. Damage to bones or nerves can also accompany these injuries.
This damage can be accompanied by:
- localized pain
- redness or bruising
- limited range of motion
- decreased function
How and why do these symptoms appear? A cascade of events occurs following a traumatic injury:
- The twisting, tearing, or blunt force trauma leads to the microscopic damage of small blood vessels and connective tissues.
- This microscopic damage results in blood, plasma, and cellular fluid leaking into nearby tissues.
- The leaking of fluid, along with the collection of chemical mediators and dilation of blood vessels, cause acute injury swelling.
- As the blood migrates towards the skin’s surface, the skin may appear dark red or have the characteristic “black and blue” appearance of bruising.
- The sensation of pain is a result of the fluid collection, certain chemicals released in the body (as a result of cellular injury), and lowered oxygen levels in the soft tissue (hypoxia).
Symptoms can vary greatly depending on the severity of the trauma and the area of the body that is injured.
Protection, Rest, Ice, Compression and Elevation, or P.R.I.C.E., adds the concept of “protection” to the traditional R.I.C.E. protocol formula. Protecting the injured area from further damage is crucial to the healing process.
Experts recommended acute injury patients use P.R.I.C.E. shortly after the injury occurs. It may be particularly helpful during the first 24 to 72 hours.
P: Protection is meant to prevent further injury. For example, an injured leg or foot may be protected by limiting or avoiding weight-bearing through the use of crutches, a cane, or hiking poles. Partially immobilizing the injured area by using a sling, splint, or brace may also be a means of protection.
R: Rest is important to allow for healing. However, many sports medicine specialists use the term “relative rest” meaning rest that allows for healing, but is not so restrictive that recovery is compromised or slowed. A person should avoid activities that stress the injured area to the point of pain or that may slow or prevent healing. Some movement, however, is beneficial. Gentle, pain-free, range-of-motion and basic isometric contractions of the joints and muscles surrounding an injury have been shown to speed recovery.
I: Ice refers to the use of cold treatments, also known as cryotherapy, to treat acute injuries. Ice is recommended with the intent to minimize and reduce swelling as well as to decrease pain. There are many ways to employ cryotherapy at home. The most common and most convenient is a simple plastic bag of crushed ice placed over a paper towel on the affected area. It is important to protect the skin and limit the cold exposure to 10 to 15 minutes. Cycles of 10 to 15 minutes on and 1 to 2 hours off are generally agreed upon as effective and safer than longer periods of continuous ice application.
Skin sensitivity or allergy to cold exposure can occur. It may manifest as skin that becomes mottled, red and raised where the ice contacted the skin. If this is experienced, the ice treatments should be discontinued. Redness alone, however, is common and should resolve after a few minutes of re-warming.
C: Compression is the use of a compression wrap, such as an elastic bandage, to apply an external force to the injured tissue. This compression minimizes swelling and provides mild support.
Applying an elastic bandage does require some attention to detail. It should be applied directly to the skin by starting a few inches below the injury and wrapping in a figure eight or spiraling manner to a few inches above the injured area. A medium amount of tension should be applied to provide ample, but not too constrictive compression. The bandage should not cause numbness, tingling, or color change of the soft tissue. Loosening the bandage should quickly alleviate these should they occur. It is generally best to remove or significantly loosen the elastic bandage for sleeping and to re-apply it the next morning.
E: Elevation is recommended to help reduce the pooling of fluid in the injured extremity or joint. Controlling swelling can help decrease pain and may limit the loss of range of motion, possibly speeding up recovery time.
Elevation is accomplished by positioning the injured area above the level of the heart. Elevation during most of the waking hours, if possible, and positioning the injured limb on extra pillows for sleep is probably most effective in the initial 24 to 48 hours. If there is significant swelling which continues after 24 to 48 hours, or if swelling recurs during recovery, then continued periodic elevation is appropriate.
For many sports and exercise injuries, ice can be secured over the affected area with an elastic bandage and the limb can then be elevated, achieving simultaneous Rest, Ice, Compression and Elevation—the optimum home treatment.
In addition to the steps outlined in P.R.I.C.E, additional treatments can help alleviate symptoms.
- Patients in need of pain relief can use over-the-counter creams, patches, acetaminophen, or non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen.
- To reduce the build-up of fluid that leads to swelling (edema), patients can try light massage around the head and/or gentle range-of-motion exercises for the affected joints and soft tissue.
- Isometric muscle contractions can improve and maintain strength and function. For example, a patient with a leg injury can repeatedly flex and relax the calf and thigh muscles while sitting still or lying down; the leg muscles “fire” and are exercised even though the leg itself does not move or bear weight.
A medical professional may be able to suggest treatments specific to particular person or injury.
Things to Avoid
Some treatments can cause more harm than good. Below is a list of things that can aggravate an acute injury:
- Hot water exposure or heat treatments to the injured area
- Stretching, movements, or weight bearing activity that is painful
- Aggressive, deep massage
- Ice or commercial cold packs placed directly on the skin
- Advice contrary to common sense or widely accepted principles of basic injury care
Patients who are unsure how to treat their injury should contact their doctor’s office.
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