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MANAGEMENT OF ACUTE INJURY

Dr Tom Cross

The adherence to the principles of R.I.C.E. particularly in the first 24-36 hours after injury can have an enormous impact on the speed at which an athlete returns to normal athletic activity.

RICE is attempting to minimise the extent of acute inflammation that follows the acute tissue injury. In particular RICE is aiming to minimise bleeding and tissue oedema. It is this excessive tissue haemorrhage and oedema that prolongs the repair of the tissue and return to function.

Practically it involves:

• REST:
  Stop exercise as soon as possible. Minimise physical activity over the next 24-36 hours. If the injury is to the lower limb and weight bearing is painful, crutches are indicated until weight bearing is comfortable.

• ICE:
  Ice 20 minutes every hour for the first 6 hours then 20 minutes every 2 hours for the next 18 hours. Try to achieve at least the first 6 hours of treatment before sleeping.

• COMPRESSION:
  Compression bandaging minimises tissue swelling. It should be applied in between icing sessions and while sleeping.

• ELEVATION:
  Elevate the injured limb for as much as possible. The leg needs to be above the hip.

Always advise injured athletes that alcohol increases the acute inflammatory response to their injury and thus will prolong recovery from the injury.

For acute injury to tendons, ligaments and joints Non Steroidal Antiinflammatory medication is indicated. Both topical (gel- over the counter) and oral NSAIDS (prescription required) are effective.

When should you consider referral for a medical opinion? A good rule of thumb is to be guided by the person’s loss of normal function. For example if the patient is unable to weight bear on the injured leg or move the injured neck/back/shoulder/hand etc through at least 50% of the part’s normal range of motion referral is indicated.

If a joint swells within 1-2 hours of an injury this indicates a haemarthrosis (blood in the joint) which suggests serious injury to the joint. For example rupture of the anterior cruciate ligament of the knee (requiring knee reconstruction) classically is associated with a swollen painful stiff knee within 1 hour.