Management of acute soft tissue injury: forget PRICE, call the POLICE!Pete Kissel
The acronym PRICE (protection, rest, ice, compression and elevation) has attained superstar status and has become the automatic reflex recommendation for many sports medicine practitioner’s for decades. This has trickled down to a household acronym that many athletes religiously rely on. Surprisingly however there have been relatively few high quality investigations supporting the individual components or the treatment package as a whole.
One component of the PRICE principle that has come under recent scrutiny is the concept of “rest”. Short period of unloading are necessary after acute soft tissue injury and aggressive loading or exercise should be avoided(to prevent re-bleeding or further damage). However, prolonged rest may be harmful and inhibits recovery. Progressive mechanical loading promote cellular responses that restores the strength and morphological characteristics of collagenous tissue. In research this is called mechanotherapy….in clinical terms we call this functional rehabilitation.
In a recent clinical trial from the UK comparing PRICE management to early mobilisation with accelerated rehabilitation (mechanotherapy group) after acute ankle sprain found a quicker functional recovery in the early mobilisation and exercise group. The key to mechanotherapy after acute soft tissue injury is replacing rest with optimal loading.
Exit PRICE…enter the POLICE! POLICE is a new acronym representing protection, optimal loading, ice, compression and elevation. This is not a cookbook formula. It is meant to stimulate clinicians to include mechanotherapy, which includes a wide range of manual techniques and exercise loading strategies, and de-emphasize rest as a primary treatment recommendation.
The challenge is in determining what is ‘optimal’ in terms of the dosage, nature and timing. Type of tissue injured, severity of the injury and anatomical location are all factors that need to be considered to design a rehabilitation strategy that aspires to achieve optimal loading. Ask your sports chiropractor about functional rehabilitation for your acute soft tissue injury.
Bleakley CM, Glasgow P and MacAuley DC. Price needs updating, should we call the police? (editorial). Br J Sports Med doi:10.1136/bjsports-2011-090297
Bleakley CM, O’Connor SR, Tully MA et al. Effect of accelerated rehabilitation on function after ankle sprain: randomized controlled trial. BMJ. 2010;340:1964.