You’re Injured, now what?

So you’re injured… hey it happens, what do you do next? 

Chances are you have heard the acronym RICE (Rest, Ice, Compression, and Elevation) as the best way deal with an acute injury. RICE makes a ton of sense for so many reasons… Your doctor always tells you to rest after injury, ice helps to dull the pain, while compression and elevation can reduce swelling.  However; as logical as it may seem, “RICE-ing” your injury may not be the fastest or the best way to heal yourself. 

What happens during and after injury?

Let’s get technical for a moment… Injuries occur when the load applied to a tissue is greater than the tissues capacity to deal with said load. Let’s look at a twisted ankle as an example: The twisting action is more force (load) than the ankle can handle and as a result, the ligaments (tissue) of the ankle tear apart (injury). When tissues are damaged an immune system response, which is the same response when we get sick, is triggered. So our body sends blood, fluids, and other things like nutrients to the site of damage in order to kick start the healing process but also to restrict movement. In addition to the immune response, we also receive nerve signals from and to the injured area to stop you from moving it, preventing more damage from occurring. 

How do I deal with swelling?

As soon as inflammation and swelling starts to happen most of us instinctively go to the RICE method but it turns out this method may actually inhibit healing. There is no question we need to reduce inflammation and swelling but ice packs don’t do a great job. Ice packs can help to numb an area when an injury first occurs, so they are useful to ease pain; however, cold restricts blood flow to injured tissues that desperately need things like oxygen and nutrition. Heat seems to be a better option given that heat promotes blood flow through the injured tissues and can soothe an overactive nervous system, promoting healing and reducing pain. 

Is heat is the new ice?

Yes and no. Heat packs work well but are a localized treatment and can be difficult to get in the “right place”. Hot tubs or whirlpools provide “wet” heat that helps penetrate deeper layers of tissue and are considered a better option. Infrared saunas are becoming more popular because the infrared light waves produced by the sauna help to increase blood flow and there may be some benefit to using light for healing. But don’t dismiss the effect of cold completely; whole body cooling to increase blood flow and circulation is also a fantastic tool to use for injury management. Ice baths are easy to setup (all you need is a tub, water, and ice) and provides rapid whole body cooling but temperatures are not well standardized and are generally something people have trouble withstanding. Whole Body Cryotherapy (like at Sparkling Hill) is the ultimate in whole body cooling and is safe, controlled, while providing an excellent circulatory boost. Other benefits of Whole Body Cryotherapy are that they are faster, more hygienic, and more tolerable because it is a dry cold, compared to a typical ice bath. 

Can drugs help?

Pharmaceuticals that aim to reduce inflammation, just like ice, can be used in the initial stage to help reduce the initial swelling in order to get out of a high pain state but should be generally avoided when possible. Anti-inflammatory medications more often than not work by inhibiting our body’s natural immune system response, which is not ideal. Remember that in order to heal we need “inflammation” since it helps deliver blood and nutrients to injured areas. Consequently, anti-inflammatory medications may actually delay healing.

Should I move more? Or move less?

After an initial injury occurs it is important to start moving again as soon as possible and as much as possible, albeit without creating more pain. Movement can be viewed as serving two primary purposes during rehabilitation: One, to ensure we lose minimal range of motion after an injury occurs, and two; to promote proper tissue growth and direction. “Use it or lose it” is a real thing, especially when it comes to movement. The stiffness following an injury can be attributed to our body essentially unlearning movements because we restricted movement an attempt to reduce pain. If the body can’t move into a painful range we have no pain, but most of us would like to move and not stay bed-ridden.

Think back to the nervous system response from the initial injury? After the tissues start to heal we also have to re-train our nervous system to accept movement as safe again. If we can reintroduce movement as soon as possible, in pain free ranges, we will lose far movement. Early and often moving helps to stimulate proper tissue growth (i.e. muscles, tendons, ligaments, bone, etc…) instead of scar tissue propagation (i.e. disorganized tissues).

What about Compression (C) and Elevation (E) of the RICE acronym?

Compression is great tool to help muscles stay a little closer to each other instead of bouncing around out of control when going through some rehabilitation and exercises. Compressing and elevating an injury also help with the inflammation and swelling after injury but as we just discussed movement generally seems to be more beneficial. Elevating an injury too long may again inhibit blood flow; furthermore, compression that is too tight can also inhibit blood flow. 

I’m healed when I’m pain free, right?

Unfortunately a lot of rehabilitation programs fall short as they are designed only to get you back to a pain-free state, not a fully functioning human state. Even more unfortunate is when a person stops rehabilitating because insurance money runs out. Continuing to promote healing and proper tissue development is important for everyone, not just professional athletes. Because we think as soon as we don’t have pain we can go back to the movements that caused injury, instead of training our tissues to handle our demands, re-injury often occurs.

You owe it to yourself to make sure you have a working human body; 

Not just a pain free body.

Paul Bradshaw l Kinesiologist

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