Acute Injury Management

The effectiveness of the immediate management of a soft tissue injury determines how quickly and well the injury will heal. Whether the injury is a traumatic one (for example sprained ankle) or an overuse injury (archilles tendonitis), the body responds with a reaction called "inflammation". The inflammatory process is a necessary reaction to tissue damage, which eventually leads to healing of the injured area.

Inflammation is a four stage process; the first stage is a chemical response, where substances such as bradykinin and serotonin are released at the injury site. These chemicals have a number of effects. They stimulate pain sensitive nerve endings and help the next stage of inflammation to proceed. The second stage is known as the cellular response, where white blood cells such as macrophages, leucocytes and others invade the injured area. The role of these cells is to help remove the damaged tissue and establish an environment where new tissue can be laid down. The third part of this process is the laying down of new tissue - largely proteins such as collagen and fibrin. Remodeling is the final stage of healing. The new muscle, tendon or ligament tissue is strengthened by the addition of "ground substances" - so that a strong structure is finally formed.

The length of this process varies, depending on the individual, type of injured tissue and the degree of trauma. The first two stages of inflammation can take ten to fourteen days, and the whole process anywhere between two weeks, and nine months. For example, a mild muscle strain can be healed within two weeks, while a serious ligament sprain or tear may take nine months to recover full strength and function.

It is during the first two stages of inflammation where "first aid" management can help minimize the extent of an injury, and speed the process of healing. To best achieve this R.I.C.E. regime should be used. R.I.C.E. stands for:

REST
ICE
COMPRESSION
ELEVATION

One of the major problems in a soft tissue injury is that when any muscle, tendon or ligament is damaged, some blood vessels are also torn. These damaged vessels bleed into tissue surrounding the injured site and actually cause more damage. Resting the injured area reduces the amount of blood flow to these torn vessels. Rest should not be seen as "doing nothing" - rather as:

Reducing
Exercise to below the,
Soreness
Threshold

Ice has a number of beneficial effects in acute injury management. Although most medical and paramedical practitioners agree that ice is beneficial, there is some disagreement and fairly poor evidence which shows exactly how cooling injured soft tissue helps.

Icing an injured area does help to clamp or close torn blood vessels - thus reducing bleeding. It also helps to slow the metabolic demands of the damaged tissue which reduces the amount of oxygen and nutrients required. Reducing this metabolic demand helps minimize the amount of cell damage due to bleeding associated with injury. Ice also helps to reduce the pain of injury by reducing the output of nerve fibers in the area (numbing effect) and also reducing the activity of the chemicals (serotonin, bradykinin) released during the lymphatic system in the area. The lymphatic circulation plays an important role in removing the waste products of the inflammatory process.Compressing an injured area also helps to stop the bleeding from torn vessels and thus reduce the extent of injury.Elevating the area of damage similarly helps to slow the bleeding from damaged vessels, as well as helping venous return and lymphatic flow.

The question of how long and how frequently to ice is one that is also somewhat contentious. Some research has shown that in 20 minutes of icing an area, a maximum cooling effect is achieved. Re-icing an area before the circulation has recovered brings about the risk of "ice-burn" or frostbite. It is therefore advisable not to re-ice an area until the characteristic redness or erythema that occurs following icing disappears. When the skin color returns to normal, this indicates the superficial circulation has recovered.

source: Sports Injuries : Diagnosis and Managment by James MD