Acute Injury Management

    The most important time in the treatment of acute injuries is in the first 24-72 hours post injury. When tissues are injured – muscles, tendons, ligaments etc – blood vessels are usually damaged too. This results in an accumulation of blood which can lead to further tissue damage, compression of other structures which can cause hypoxia – reduced oxygen – and further tissue damage. So what is the best thing to do immediately after an injury to accelerate recovery? It can be neatly summarised by following the RICE regime.


    Adequate rest of the affected area is needed in order to decrease bleeding and swelling. The body can then begin healing without the risk of further injury. For injuries of the legs crutches are often sensible, and for injuries of the arm a sling can be useful.


    Ice is used to reduce tissue metabolism, help with pain and swelling. While there is some debate surrounding how often and for how long ice should be applied, we suggest applying ice for 15-20 minutes every 1-2 hours. There is good research suggesting a minimum of 10 minutes is required, while anything more than 20 minutes seems counter productive. Ice can be applied a number of ways, though something simple such as a frozen bag of peas works well. Applying a damp cloth between the ice and the skin is important to reduce the risk of ice burns.


    Compression helps to reduce bleeding and therefore swelling. It can also provide support. A bandage should be applied firmly but not so tight as to cause pain or stop blood flow to the hands or feet…you’ll miss those if they fall off.


    Elevation of the injured area reduces swelling, and hopefully you’re realising that preventing swelling is important. The injury site should be placed above the level of your heart when lying down. If you have injured your knee or ankle it is important to have your leg raised onto a chair.

    Is there anything you should avoid in the first stages after injury?

    For 2-3 days you need to avoid some things that you probably enjoy…..heat packs or heat rubs, alcohol, vigorous massage, and moderate to intense activity. They all act to increase swelling or increase blood flow.

    So while it’s often difficult to avoid injury, by following the above regime you will substantially reduce many of the problems we face once injured, return to normal faster, and require less Physio!