Dealing with Acute Injuries

ACUTE INJURIES

Acute injuries are initially treated with the PRICEM principles.  The sooner the PRICEM principles are initiated the better.  Remember that swelling may increase over the first 48 hours.

P - protect the injured area from further injury such as the use of crutches, limited weight bearing, etc
R - rest the injured area</li>
I - ice the injured area 10-15 minutes at a time up to every hour
C - compression to limit swelling through use of a tensor bandage, etc
E - elevation of the injured area
M - medication/modalities such as anti-inflammatory medication, ultrasound, electrical stimulation, etc.

Injured tissue goes through three overlapping stages of healing

1. Inflammatory - the body reacts to the injury by swelling and begin to lay down new collagen tissue.  The new collagen is weak therefore stress should be minimized.  This stage lasts 7-10 days.
2. Fibroblastic - this stage lasts 4-6 weeks and is characterized by increased density of new collagen tissue.  Gradual stress through the injured area is critical to resume optimal function.
3. Maturation - this stage can last up to one year and the collagen tissue remodels itself in reaction to the stress placed upon it.

The key to rehabilitation during the acute phase is to gradually increase the stress placed upon the tissue matching the stages of healing and the severity of the injury.

OVERUSE INJURIES

Overuse injuries take two forms, which often overlap.  The first is simple overuse where an athlete has increased their training or has a sudden change in training to a level that has over stressed the tissue.  Treatment is to identifying the stressful event(s); decrease the inflammation and providing rest to the injured area.

The more common overuse injury is where the painful injured tissue can no longer handle the demands placed upon it.  This requires a more in depth assessment to determine what is the cause of the injury.  Quite commonly the injured area is the ‘victim’ of stiffness / lack of mobility and or control elsewhere in the body termed the ‘culprit’.  For example if a runner is complaining of lower back pain ‘the victim’, while ‘the culprit’ might be a lack of hip mobility, putting extra stress on the lower back.  The assessment should include looking at the intrinsic and extrinsic factors of each individual.

Intrinsic Factors:

• Biomechanical examination of joint mobility and stability
• Bony structure: Spine and limbs
• Ligament stability
• Muscles Activation /Strength
• Body Awareness / Balance
• Posture

Extrinsic Factors:

• Training Methods
• Shoes, bike, other equipment