Police by Stephen Coleman
Acute Injury Management – POLICE Principle
by Stephen Coleman
The current best practice for acute injury management follows the POLICE principle. POLICE is an acronym that stands for Protection, Optimal Loading, Ice, Compression and Elevation. Previously RICE & PRICE were used to signify rest and protection, but in recent years this has been modified to favour optimal loading over rest.
Protection of the injury is vital in the acute phase and can take several forms. This does not mean complete immobilisation is necessary but may mean offloading the tissue with crutches, or may mean discontinuing the activity that caused the injury – for example, being subbed off the pitch instead of playing on or “playing through” the injury. Protection is based on the principle of preventing further tissue damage.
Optimal Loading is based on allowing bone, muscle and soft tissue, such as tendons and ligaments, sufficient load to stimulate healing, without providing too much, so as to not increase inflammation and further irritate the injured tissues. This varies greatly from injury to injury with the likes of a fracture requiring further assessment and treatment. For some injuries, crutches, braces and supports can help regulate the amount of loading that is placed on the affected tissues. As well as helping stimulate healing, optimal loading can also help manage swelling in certain instances.
Ice – otherwise known as cryotherapy has several mechanisms of action. Firstly, it’s proposed that ice reduces swelling by increasing vasoconstriction (blood vessel constriction). This can have a positive impact on joints by decreasing the amount of pressure in the area which can allow for more effective range of motion exercises, which several studies suggest is important in the acute phase of injury. Ice also affects nociceptive pathways – in other words, ice reduces the painful neural message that travels to the brain so we can perceive a reduction in pain in the area. There are precautions to keep in mind when using ice therapy as prolonged exposure can cause skin and even nerve damage. Certain conditions may also render ice therapy inappropriate such as Raynaud’s, diabetes or people with circulatory problems. There are no specific dosages for ice application but some studies suggest 10 minutes on, 10 minutes off is the best approach.
Compression of the injured area can help reduce swelling or bleeding in an affected area. Compression bandages can be used and should be applied distally to proximally (the furthest point from the body to the nearest point), i.e. for an ankle injury, it should be applied from the foot upwards and not the other way around.
Raising the injured area promotes venous return of blood to the heart which should further help reduce inflammation and it also reduces internal pressures in the area.