Managing Soft Tissue Injuries

March 29, 2018 | Jane Grainger

The acronym PRICE has been central to soft tissue injury management for many years.

P protection
R rest
I ice
C compression
E elevation

Protection and Rest

Initially rest and protection is required in the early stages to prevent re-bleeding and re-rupture at the injury site. The type of protection needed depends on the injury and may include taping, slings, non-weight-bearing or just a bit of looking after it.

The advice to rest after an injury is sometimes misinterpreted- the rest should not mean lack of movement but actually just avoiding re-injury. There is growing evidence to support gentle exercise and progressive tissue loading to improve the healing process of the damaged tissue. Working or loading muscle, ligament or tendons (soft tissue) simulates cellular changes and promotes tissue healing.

However stressing a tissue too aggressively of course would cause further injury. It is important to strike a balance of gentle loading that is beneficial and not harmful. Pain is a good indication of the level to work at.

Ice

Ice remains an important component of soft tissue injury management. Ice is important to reduce the skin temperature promoting pain relief. There is no evidence to suggest that it reduces inflammation however it does help to reduce swelling and I feel anecdotally that ice is a very important component of management for swelling and healing.

Compression

Initially compression can be used to reduce bleeding, and then after the initial bleeding risk is over a more gentle compression can help to reduce swelling.

Elevation

Helps with swelling reduction.

Swelling (oedema) is a sign of acute inflammation. After soft tissue injury some components of inflammation are essential for healing, however prolonged swelling can reduce down the effectiveness of the healing process. Management to reduce the swelling includes elevation, gentle compression and Ice.

Crucially post injury we need to promote the healing process and avoid things that slows it down – for example alcohol intake, excessive load-bearing, heat, over use and possibly avoid NSAID’s.

What next?

So after the initial or acute phase your injury will enter the sub acute phase.

Pain relief

Manage the pain with ice, gentle massage and pain killers (if you are able to take them).

Range of movement

One of the first aims after an injury would be to regain your full range of movement in that joint. Gently take the joint or limb through its full range to regain normal movement.

Strength

You will need to work on strengthening any tissue that has been injured. This will require load bearing and resistance work.

Proprioception

This is the ability for the joint to know where it is in space. Injury to soft tissue affects the signals that are sent to the brain concerning how the joint is moving. It is very important to regain this to prevent further injury, for example an ankle sprain: without working on proprioception the ankle is likely to roll again when it is challenged on uneven ground.

Longer term Rehabilitation

Rehabilitation may include sport or injury specific exercises, strengthening training, proprioception work and stretches. It depends on the injury and individual as to the advice required at this stage.

Physiotherapy can help, treat and guide you at any stage of injury should you need it.