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Musculoskeletal injuries are injuries and disorders that affect the musculoskeletal system (i.e. muscles, tendons, ligaments, nerves, discs, blood vessels, etc.).

They can either be acute (as a result of a single traumatic event that causes macro trauma to the body part) or chronic (exercise-induced or overuse injuries which are subtler in nature and usually occur over a longer period of time).

Acute musculoskeletal injuries occur frequently and in different forms ranging from muscle strains, ligaments sprains, muscle contusions and they are usually as a result of a direct trauma or an abrupt change in direction (usually as a result of a fall or slip) when walking or when there is a direct trauma or blow to any part of the musculoskeletal system.

As an example, consider yourself walking or running and you suddenly slip and sprain your ankle ligaments or strain the muscles around your ankle and foot which results in serious pain, reddness and swelling of the ankle region ( an inflammatory mechanism that the body employs to protect the area), what would you do?

Here, I will explain the necessary actions to take after an acute musculoskeletal injury and also the actions that you shouldn’t take in a likely scenario.

What to do after an acute musculoskeletal injury

The management of acute injuries includes protecting, optimal loading, icing, compressing and elevating of the affected part and can be explained using the acronym P.O.L.I.C.E.

In isolation the components have some benefit but in order to optimize the tissue recovery process, a combination is advised. Early intervention and graded activity will enhance tissue recovery but due to the variability of injuries and their severity, there is not one standardized strategy or dosage.  Yet treating appropriately and increasing the load gradually as you recover can help you gauge what your tissues can tolerate.

Protection

The first thing to do in the event of an acute musculoskeletal injury is to protect the area. During the first few days after an injury, you should certainly rest the injured joint, ligament, or muscle.

After a few days, gentle motion can be started while you still maintain a level of protection for the injured area. During this time you may require some sort of assistive device, like crutches, to walk. A brace or orthotic device can be worn around the injured area for protection.

Optimum Loading

The next thing to do while protecting the area is to optimally load the area. This can be achieved by the gradual loading of tissues to stimulate their ability to tolerate load (resistance) and to align tissue make up. This could be gently moving the injured limb, graded resisted exercises, massage, using crutches or a brace to support the tissues.

Optimal loading is done for a short duration with a progressive approach to increasing loading as the tissue repairs and becomes stronger.

Ice

Ice is applied in order to reduce the pain and swelling around the region due to its analgesic effect (reduction in nerve conduction) and effects on blood circulation (vasoconstriction). The agreed time frame for the application of ice is about 5-15 minutes with periods of reapplication throughout the day, which can gradually tier off as tissues recover.


Fig 2: Applying ice helps reduce the pain and prevents swelling.

Compression

The use of bandages can be used to reduce swelling by reducing blood flow to the area. It also helps to make the injured region feel better. Elastic bandages are most commonly used. Special boots, air casts, and splints can serve a dual purpose of compression and support.

Be sure not to apply excessive compression which would act as a tourniquet and interfere with your blood circulation. If you feel throbbing pain, the bandage is probably wrapped too tight; take it off and put it back on a little looser.


Figure 3: Braces support and compress the painful area and therefore reduces swelling.

Elevation

Elevate the injured part of the body above heart level. This provides a downward path for draining fluid back to the heart, which may reduce swelling and pain. Try to elevate the entire limb 6 to 10 inches above the heart so there is a complete downhill path. Lie down and use a pillow to help elevate the injured limb.

What to avoid after an acute musculoskeletal injury

Just like all instruction manuals always tend to tell all things to do and things not to do to ensure you get the maximum productivity from your devices, there are also some practices that should be absolutely avoided just after an acute musculoskeletal injury. You should always remember to do no H.A.R.M.

Heat

Applying heat to the injured area will cause a widening of local blood vessels in the region leading to an increase in blood circulation (vasodilation) to the area which in turn causes an increase in the inflammatory reaction around that region thereby leading to increased swelling, redness and pain in the region.

This will delay healing of the tissues of the region it is therefore advised that you desist from anything that will increase the local temperature of the region.

Alcohol

Applying alcohol also increases the local temperature and increase bleeding in the area thereby delaying healing.

Re-injury

Excessive exercise causes re-injury which slows down relief and healing. Healing tissue isn’t strong enough to manage the impact in running and is likely to breakdown causing further injury.

Massage

Massage is also thought to increase bleeding and swelling, so I would avoid massaging directly over the injured area. A Physiotherapist may choose to massage distal to the swelling (further down the limb) to help reduce swelling.

How physical therapy can help

The P.O.L.I.C.E. principle is a simple method to try after acute injury, but a visit to your physical therapist may be necessary. He can first help you figure out the best protection for your injury. Your physical therapist can advise you on exactly how much protection your injured body needs, and he can tell you when it is time to stop protecting the injury and start using the injured body part.

Your physical therapist can also guide you in the “optimal loading” part of the P.O.L.I.C.E. principle. After an injury, you may be required to perform simple exercises and motions to allow your injured muscle or ligament to heal properly. As your injury heals, your physical therapist can reduce or increase or even change your exercise routines. This is to ensure that optimal loading and proper healing occurs so that when things are fully healed you will be able to return to your functional activities of daily living without complications like joint stiffness and reduced muscle strength.

Sources

https://www.verywellhealth.com/the-police-principle-for-acute-sprains-and-strains-2696549 assessed on 29th January, 2019.

https://www.researchgate.net/publication/42975903_Best_practices_in_the_rehabilitation_of_acute_musculoskeletal_disorders_in_workers_with_injuries_An_integrative_review_and_analysis_of_evolving_trends assessed on 29th January, 2019.

https://thenakedphysio.com/2014/09/15/optimal-loading-optimize-recovery/ assessed on 29th January, 2019.

https://www.running-physio.com/acute2/ assessed on 29th January, 2019.