sports pain

Peace and Love, it's what do do with a new injury!

When you first injure yourself, the first thing to do is ➽ P.E.A.C.E

Following the first few days add in the ➽ L.O.V.E

 

A QUICK LOOK HERE, WITH MORE EXPLANATION BELOW!

If you find yourself with a new soft tissue injury, the most recent evidence supports a different approach than you might be used to.

  

RATHER THAN RICE: REST ICE COMPRESSION AND ELEVATION.

  

NOW WE WANT YOU TO USE P.E.A.C.E. RIGHT AWAY AND THEN L.O.V.E. A FEW DAYS AFTER.  

 

P.E.A.C.E.

P: PROTECT Unload or restrict movement for 1 to 3 days to minimize internal bleeding, prevent stretch or aggravation of the injured fibers and reduce the risk of increasing the injury. Rest should be minimized as prolonged rest can compromise tissue strength and quality. Do as much as you can without increasing the pain after,

E: ELEVATE  When resting don’t keep an ankle down on the floor off a chair, but rest it on a chair next to you, for an arm, place it on a pillow next to you rather than resting it in your lap.

A: Avoid Anti-inflammatories if possible. Anti-inflammatory medications may potentially increase the time it takes for long-term tissue healing to complete. The various phases of inflammation contribute to optimal soft tissue regeneration and it is a necessary part of the healing process.

C: Compression External mechanical pressure using taping or bandages helps limiting intra-articular edema and tissue hemorrhage. This can help flush out the swelling and then when releasing it new fresh blood can come in and continue repair.

E: EDUCATE! Better education on the condition and load management will help avoid overtreatment.  In an era of technology and hi-tech therapeutic options, we strongly advocate for setting realistic expectations with patients about recovery times rather than chasing the magic treatment approach.  It is our job to educate our patients on the benefits of an active approach to recovery. It has been suggested that overtreatment can increase the likelihood of injections or surgery and higher costs to healthcare systems because of disability compensation (e.g. in low back pain). Additionally, fueling the ‘need to be fixed’ can create dependence on the doctor, and thus contribute to persistent symptoms.

 

 

L.O.V.E.

after the first few days (3-4 days out from injury)

L: Load: An active approach with movement and exercise benefits most patients with musculoskeletal disorders. Mechanical stress should be added early and normal activities resumed as soon as symptoms allow. Optimal loading without exacerbating pain promotes repair, remodeling and building tissue tolerance and capacity of tendons, muscles and ligaments.

O: Optimism While staying realistic, our doctors encourage optimism to enhance the likelihood of the best recovery. The brain plays a key role in rehabilitation interventions. Psychological factors such as catastrophization, depression, and fear can represent barriers to recovery. They are even thought to explain more of the variation in symptoms and limitations following an ankle sprain than the degree of pathophysiology. Pessimistic patient expectations are also associated with suboptimal outcomes and worse prognosis.

V: (cardio)Vascular Activity: Physical activity that includes cardiovascular components represents a cornerstone in the management of musculoskeletal injuries. While research is needed on dosage, pain-free cardiovascular activity should be started a few days after injury to boost motivation and increase blood flow to the injured structures. Early mobilization and aerobic exercise improve function, work status and reduce the need for pain medications in individuals with musculoskeletal conditions.

E: EXERCISE There is a strong level of evidence supporting the use of exercises for the treatment of ankle sprains and for reducing the prevalence of recurring injuries. Exercises will help to restore mobility, strength and proprioception early after injury.Pain should be avoided to ensure optimal repair during the subacute phase of recovery, and should be used as a guide for progressing exercises to greater levels of difficulty.

Managing soft tissue injuries is more than short-term damage control. Similar to other injuries, our doctors always aim for long-term outcomes and treat the person with the injury rather than the injury of the person. Whether they are dealing with a lumbar spine sprain or hamstring strain, we hope this blog post, with help from BJSM will encourage everyone to give PEACE a chance, because perhaps all soft tissue injuries need is LOVE


References

  • Van den Bekerom MPJ, Struijs PAA, Blankevoort L, et al. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults. J Athl Train2012;47: 435-43.
  • Bleakley CM, Glasgow PD, Phillips N, et al. Guidelines on the management of acute soft tissue injury using protection rest ice compression and elevation. London: ACPSM, 2011.
  • Bleakley CM, Glasgow P, MacAuley DC. Price needs updating, should we call the police? Br J Sports Med2012;46: 220-1.
  • Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: Update of an evidence-based clinical guideline. Br J Sports Med2018;52: 956.
  • Doherty C, Bleakley C, Delahunt E, et al. Treatment and prevention of acute and recurrent ankle sprain: An overview of systematic reviews with meta-analysis. Br J Sports Med2017;51: 113-25.
  • Duchesne E, Dufresne SS, Dumont NA. Impact of inflammation and anti-inflammatory modalities on skeletal muscle healing: From fundamental research to the clinic. Phys Ther Sport2017;97: 807-17.
  • Yerhot P, Stensrud T, Wienkers B, et al. The efficacy of cryotherapy for improving functional outcomes following lateral ankle sprains. Ann Sports Med Res2015;2: 1015.
  • Singh DP, Barani Lonbani Z, Woodruff MA, et al. Effects of topical icing on inflammation, angiogenesis, revascularization, and myofiber regeneration in skeletal muscle following contusion injury. Front Physiol2017;8: 93.
  • Hansrani V, Khanbhai M, Bhandari S, et al. The role of compression in the management of soft tissue ankle injuries: A systematic review. Eur J Orthop Surg Traumatol2015;25: 987-95.
  • Bleakley CM, O’Connor SR, Tully MA, et al. Effect of accelerated rehabilitation on function after ankle sprain: Randomised controlled trial. BMJ2010;340: c1964.
  • Kim TH, Lee MS, Kim KH, et al. Acupuncture for treating acute ankle sprains in adults. Cochrane Database Syst Rev2014;6: CD009065.
  • Lewis J, O’Sullivan P. Is it time to reframe how we care for people with non-traumatic musculoskeletal pain? Br J Sports Med2018;epub ahead of print, 25 June 2018.
  • Graves JM, Fulton-Kehoe D, Jarvik JG, et al. Health care utilization and costs associated with adherence to clinical practice guidelines for early magnetic resonance imaging among workers with acute occupational low back pain. Health Serv Res2014;49: 645-65.
  • Webster BS, Choi Y, Bauer AZ, et al. The cascade of medical services and associated longitudinal costs due to nonadherent magnetic resonance imaging for low back pain. Spine2014;39: 1433-40.
  • Khan KM, Scott A. Mechanotherapy: How physical therapists’ prescription of exercise promotes tissue repair. Br J Sports Med2009;43: 247-52.
  • Lin I, Wiles L, Waller R, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: Systematic review. Br J Sports Med2019;Epub ahead of print; 2019 Mar 2.
  • Roy JS, Bouyer LJ, Langevin P, et al. Beyond the joint: The role of central nervous system reorganizations in chronic musculoskeletal disorders. J Orthop Sports Phys Ther2017;47: 817-21.
  • Briet JP, Houwert RM, Hageman MGJS, et al. Factors associated with pain intensity and physical limitations after lateral ankle sprains. Injury2016;47: 2565-9.
  • Bialosky JE, Bishop MD, Cleland JA. Individual expectation: An overlooked, but pertinent, factor in the treatment of individuals experiencing musculoskeletal pain. Phys Ther2010;90: 1345-55.
  • Sculco AD, Paup DC, Fernhall B, et al. Effects of aerobic exercise on low back pain patients in treatment. Spine J2001;1: 95-101.
  • British Journal of Sports Medicine Blogs