At the Melbourne Sports Medicine Centre the Sports Doctors and Physiotherapists are often treating patients with acute sports injuries. In keeping with the Sports Medicine philosophy of emphasising how much a patient can do, rather than emphasising what should be avoided, we are often confronted with balancing the competing needs of rest and maintaining an appropriate level of function.
There is the well-known Sports First Aid axiom of R. I. C. E for acute injuries. In recent times a prefix referencing Protection of the body part has been added. So for managing acute sports injuries we have:-
According to the circumstances Protect might refer to the use of crutches, splint or sling. With the body part protected what follows is a period of Rest. But we need to keep asking ourselves is complete rest necessary or preferable as opposed to some sort of functional loading.
For instance, for some foot and ankle injuries crutches may be required to reduce weight bearing but in some circumstances some partial weight bearing is preferable for injury management and function over complete non weight bearing. Also an acutely painful tendinopthy may react adversely to rest and respond better to some modified loading. So whilst at times a period of Rest is necessary, at other times Rest can be unnecessary and potentially an impediment to recovery. Perhaps we would be better replacing Rest with Optimal Loading, which requires a thorough consideration of the degree of function that a patient can maintain whilst still recovering- which would leave us with:-
So you could say that we’ve replaced PRICE with POLICE, which is relatively easy to remember. However in order to implement the concept of Optimal Loading an accurate diagnosis and assessment of the patient’s current capacity is necessary. Also, Optimal Loading will vary and progress along with the recovery from injury so close monitoring is required. In comparison, the use of blanket Rest in acute injury management can be overly conservative and may not adequately prepare the patient as well for future reloading as the injury recovers. Remember that modern Sports Medicine is about minimising the disruption that the injury imposes and facilitating the rapid and seamless recovery- the Optimal Loading model can be better suited to achieving these goals than prolonged Rest.
To arrange an appointment to see one of our experienced Sports Medicine Doctors or Physiotherapists please phone 9650 9372 or book online.