Injury and Healing Within Sports Physiotherapy

Original Editor - Rpbin Tacchetti

Top Contributors - Wanda van Niekerk, Robin Tacchetti, Lucinda hampton, Kim Jackson, Jess Bell, Ewa Jaraczewska and Tarina van der Stockt

inflammatory chart

POLICE

During the acute phase discussed above, the RICE-method: Rest, Ice, Compression and Elevation was suggested. Most people are familiar with the acronym RICE when dealing with musculoskeletal injury, however, current thoughts have expanded the RICE acronym to the POLICE method: Protection, Optimal Loading, Ice, Compression, Elevation. Optimal loading or mechanical loading is the time where physiotherapists need to use good clinical decision making to assist with recovery and prevent chronic conditions from forming.

Mechanical Loading

Understanding the specific injured tissue helps target the appropriate timing for incremental loading. During this remodelling stage collagen transitions from immature type three to type one collagen.Injured tissues need to learn how to adapt to mechanical loads to in order to return to pre-injury level.  A load can be very light like a tickle, to a very high load like a manipulation.  If the load is applied is too little or too much, it can result in inappropriate repair of the tissues and create a chronic condition.   As physiotherapists, we can use many different techniques to apply loads such as massage and ultrasound.  As tissues get stronger, the applied load can increase being careful not to go overboard.  Too much tension can cause the collagen fibres to misalign causing adhesions leading to chronic conditions.

Loading Feedback

Patient feedback is critical during this stage to ensure collagen alignment and proper healing.  Asking the patient to monitor for swelling, stiffness and pain for 24 hours can help the therapist gauge the correct loading application.  In addition, therapists can monitor swelling using tape measures.

Healing Times

Healing times are dependent on the type of tissue involved.With proper management, different tissues will take different amounts of time to heal fully.  Ian Horsley estimates below the time expected per tissue:

Ligament: 1 year

Tendon: 2-3 years

Articular cartilage: greater than 3 years

Good clinical decision involves understanding the tissue, the timing to add mechanical loading, the amount of mechanical loading, monitoring for symptoms and asking for patient feedback all help give the best chance of tissue recovery to pre-injury level of strength.

Resources

• Soft Tissue Healing
• Figure Eight Measurement of the Hand
• Figure of Eight Method of Measuring Ankle Joint Swelling