If the “PRICE” isn’t right, we may need to call the “POLICE”: the management of acute sprains and strains of soft tissue.
By Dan Krebs BSc, MScPT, MClSc, FCAMPT, CGIMS.
Terminology for muscle (contractile tissue) and inert (non-contractile) tissue injuries.
- Ligament Sprain – typically used when referring to ligaments and other non-contractile components of a joint. These are classified as first degree (irritation of tissue), second degree (partial tear) and third degree (full tear or rupture).
- Muscle Strain – most commonly refers to injuries involving muscle and includes the muscle pain associated with resistance training called Delayed Onset Muscle Soreness or DOMS, all the way to complete ruptures of a muscle. These strains are also classified into the 3 levels of severity like sprains above.
Injury Healing Management
The term sprain commonly refers to ligaments or tissue other than muscle. Ligaments add structural integrity to joints, giving them stability and keeping the joints’ surfaces in approximation. Sprains to joints can occur through direct trauma (i.e.- being tackled at the knees and/or indirectly by placing large amount of stress on the joint beyond what the ligament can withstand or trying to perform a sharp pivot turn).
As with strains, sprains require similar management with potentially more emphasis on ‘P’rotection. Because ligaments can aid in the structural integrity of joints it is very important to brace the injured joint and restrict its range of motion to allow adequate scar tissue to form. Depending on the severity of injury, bracing (protection) may be required for a few days up to 3-6 weeks.
The next important step is identifying the management and treatment of these injuries. Muscle strains can occur in two ways; from direct contact with an external force (i.e.- getting hit in the leg during a tackle) or via indirect trauma, when the muscle contracts forcefully beyond its capability and causes injury to that muscle (i.e. – soccer players accelerating for a ball and strain a hamstring).
In both cases there can be varying degrees of damage, but the basic principles for managing this initial stage remain the same. However, diagnosis of the injury and its severity should be performed soon after by a qualified Physiotherapist and commonly does not require any diagnostic imaging.
After an Injury Occurs
In the first 2-3 days after injury it is important to ‘P’rotect the muscle by limiting its use as it is important for scar tissue to form a bridge between the torn strands of muscle fibres. This stage also involves ‘I’cing the affected area to decrease swelling as well as helping with pain management. ‘C’ompression with a tensor bandage or sleeve is also meant to limit swelling and improve transition to the healing phase, and finally ‘E’levation of the area to decrease pooling of fluid in the area. So far we have the “PICE”, but one more critical component is required to optimize tissue healing and increase people’s durable return to activity and that is ‘O’ptimal ‘L’oading.
Optimal loading refers to the time and force sensitive loading of the affected tissue which can improve the tensile durability of the scar bridge that forms between the torn fibres. This portion of the “POLICE” acronym is where the expertise and training of a registered Physiotherapist can play an important role in those acute muscle strains.
It is important to have these injuries evaluated by a Physiotherapist who can determine the appropriate course of treatment. If you manage these soft tissue injuries properly, they will resolve faster, and then we can get you moving faster, and feeling better.
If you are currently experiencing pain, stiffness, or discomfort from a recent or old injury, give us a call at the Beddington clinic at (587) 355-2738. Dan would be happy to help you to fully resolve your muscle or joint pain and restore you to your optimal pain free function, so you can stay active and healthy.
Move Faster, Feel Better.
Nose Creek Physiotherapy
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Maffulli N. Del Buono A. et al. Muscle Injuries: A brief guide to classification and management. Translational Medicine. 2015. 12(4): 14-18.