Have you ever injured yourself? Did you know what to do?

My guess is you’re probably familiar with the age-old acronym of RICE or PRICE - Protect, Rest, Ice, Compression, Elevation. What you may not be so familiar with is the fact that this advice has now COMPLETELY CHANGED!

So what should you do now if you suffer a soft tissue injury?

Not to sound too hippy but PEACE & LOVE...yep I’m serious this is the most recent evidence-based advice!

For the first 72 hours after sustaining an injury, the following is recommended:

This has not changed from previous advice and guidelines. It is important to protect the injured area by giving it relative rest in the early days, by not engaging in activities or movements that evoke pain.

2. Elevate

Again, this is not new information and remains from previous advice. Elevation means keeping the injured area higher than your heart (if possible!). This should be done as often as is feasible for the first three days after injury.

3. Avoid Anti-Inflammatory Modalities

Inflammation after an injury is a good thing! Inflammation is a normal part of the recovery process and a necessary step towards healing. It is recommended to avoid taking anti-inflammatory medications, using anti-inflammatory rubs or lotions and using ice as they will all slow down the healing process.

4. Compression

Applying compression to the area - through the use of tape or elastic bandage - helps to reduce swelling in the first few days after injury.

5. Education

This one is really targeted towards healthcare professionals to educate patients that an active recovery is the best approach to dealing with an injury. Passive treatment like electrotherapy (ultrasound, laser, TENS etc), manual therapy (hands-on treatments) and acupuncture are not recommended in the early stages of healing.

After the first three days of healing the following is recommended:

1. Load

To promote recovery you will need to gradually load the injured area as you resume normal activities and exercise. Listen to your body and let pain be your guide.

2. Optimism

Be optimistic about your ability to recover! Your mind plays a strong role in the healing process - positive expectations are highly correlated with better outcomes.

3. Vascularisation

Pain-free cardiovascular exercise should be started from day 3 post-injury. Examples include: swimming, cycling, walking, running, using a crosstrainer etc. This will help to promote blood flow to the injured tissues to facilitate optimal recovery.

4. Exercise

There is strong evidence that exercise improves mobility, strength, balance and proprioception (an awareness of a joint in space) after injury. Pain can be used as a guide when progressing exercises. Maintaining activity levels and taking an active approach to recovery is key!

Did you know?

Treating a soft-tissue injury optimally in the early stages reduces the likelihood that it will persist and become chronic. If you do have a chronic injury or persistent pain this blog post may be of interest to you. 

Information based on: 

Dubois, B., Esculier , J. (2020). Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine; 54, pp. 72-73.

It is estimated that 20% of the population suffer with persistent or chronic pain - a condition that has been under-recognised and under-treated for many years. As a Physiotherapist, it is the most common condition I see, usually in the form of chronic low back pain. This is my main area of interest and below is an infograph I created, as part of my Masters in the Clinical Management of Pain, to help explain what pain is and why it persists.

See tips for managing persistent pain here.

Information obtained from:

APKARIAN, A. V., BUSHNELL, M. C., TREEDE, R.-D. & ZUBIETA, J.-K. (2005). Human brain mechanisms of pain perception and regulation in health and disease. European Journal of Pain, 9, 463-463.

BASBAUM, A. I., BAUTISTA, D. M., SCHERRER, G. & JULIUS, D. (2009). Cellular and Molecular Mechanisms of Pain. Cell, 139, 267-284.

JAMES, S. (2013). Human pain and genetics: some basics. British Journal of Pain, 7, 171-178.

NIJS, J., PAUL VAN WILGEN, C., VAN OOSTERWIJCK, J., VAN ITTERSUM, M. & MEEUS, M. (2011). How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain: Practice guidelines. Manual Therapy, 16, 413-418.

SCHAIBLE, H.-G. (2015). Emerging Concepts of Pain Therapy Based on Neuronal Mechanisms. In: SCHAIBLE, H.-G. (ed.) Pain Control. Berlin, Heidelberg: Springer Berlin Heidelberg.

WOOLF, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152(3), S2-S15.

Chronic pain affects 20% of the population however it has been under-diagnosed and under-managed for years. The International Association for the Study of Pain defines chronic or persistent pain as pain that lasts or recurs for more than three months. A great deal of progress has been made in recent years in regards to chronic pain and it has now been included in the International Classification of Diseases as a condition in its own right.

Chronic pain is an individual experience however there are some commonalities. Most people living with chronic pain report emotional distress or psychological distress of some description.

Why is physical activity so important?

Physical inactivity is the fourth leading global risk factor for mortality, after high blood pressure, smoking and high blood glucose levels. Overall, physical inactivity is the cause of 3.2 million deaths worldwide!

Being physically active has an array of health benefits:

• Reduces the risk of heart disease and stroke
• Improves cognitive (brain) health
• Helps with weight management
• Improves bone health
• Reduces the risk of falls
• Improves sleep
• Reduces the risk of dementia
• Improves your ability to do daily activities
• Reduces the risk of certain cancers and type 2 diabetes
• Improves psychological health

How physically active do we need to be?

We should aim to be physically active everyday - any activity is better than none!

Adults of all ages should aim for at least:

• Muscle strengthening exercises on at least 2 days per week.

• 150-300 minutes moderate intensity exercise per week.
• E.g. walking, dancing, cycling, hiking etc.
• You should be able to talk but not sing!

• 75-150 minutes of vigorous intensity exercise per week.
• E.g. jogging/running, cycling up hill, swimming, aerobics etc.
• You will find it difficult to talk at this level!
   

Adults > 65 years of age & those living with chronic conditions should include:

• Exercises incorporating balance and strengthening components at least 3 days per week.
• E.g. pilates, tai chi, yoga, etc.

Most importantly: some exercise is better than none!

Cut down on time spent sitting!

Unfortunately modern lifestyle has us sitting much more than we used to. We have all heard the term “sitting is the new smoking” - but is it really?

In a study carried out in 2010, sitting for prolonged periods during the day was found to be associated with:

• 112% increase risk of diabetes
• 147% increase of a cardiovascular event occurring

Research shows that these effects cannot be eliminated by just meeting physical activity guidelines, sedentary behaviour must also be cut down.

Take home message: Keep active & reduce your time spent sitting!

Sources:

Ding, D., Mutrie, N., Bauman, A., Pratt, M., Hallal, P.R. and Powell, K.E. (2020). Physical activity guidelines 2020: comprehensive and inclusive recommendations to activate populations. The Lancet, 396(10265), pp.1780-1782.

National Centre for Chronic Disease Prevention and Health Promotion: Division of Nutrition, Physical Activity and Obesity: Benefits of Physical Activity (updated 2020).

Owen, N., Healy, G. N., Matthews, C. E., & Dunstan, D. W. (2010). Too much sitting: the population health science of sedentary behavior. Exercise and sport sciences reviews, 38(3), 105–113.

Wilmot, E.G., Edwardson, C.L., Achana, F.A. et al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia 55, 2895–2905 (2012).

There are different types of arthritis, in this blog post I am specifically relating to osteoarthritis, the most common form of arthritis which primarily affects the hip and knee joints.

Osteoarthritis typically causes:

• Pain
• Stiffness
• Reduced movement of the joint
• Reduced function which may affect day-to-day activities.

The National Institute for Healthcare & Excellence advise that osteoarthritis can be diagnosed clinically without an X-ray if the individual:

• is over 45,
• has activity-related joint pain and
• Has no morning joint-related stiffness.

Structural changes on X-rays do not always correlate with the severity of pain the individual feels; for example, minimal changes on a scan may be associated with severe pain or the individual may experience very mild pain yet display modest changes on an x-ray.

Myths:

The most common myth about arthritis is that it is a normal process of ageing and gets worse as you get older - this is not true!

Treatment:

There are effective strategies that can improve pain and function for those with arthritis. The National Institute of Healthcare & Excellence advises all treatment plans for arthritis must include exercise. It is recommended for all ages and all pain levels. The exercises should include:

• Local muscle strengthening (e.g. pilates, weighted exercises)
• Aerobic exercise (e.g. walking, swimming, cycling)
• Stretching (e.g. pilates, yoga, home exercise programme)

Recent Cochrane systematic reviews (the highest level of evidence) found that exercise reduces pain and improves function in individuals with hip and knee arthritis.

Take home message: Exercise is the core recommendation for the management of arthritis.

Information based on:

Fransen, M., McConnell, S., Hernandez‐Molina, G., Reichenbach, S. (2014). Exercise for osteoarthritis of the hip. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD007912.

Fransen, M., McConnell, S., Harmer, AR., Van der Esch, M., Simic, M., Bennell, KL. (2015). Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD004376.

National Institute for Health and Care Excellence (2014, reviewed 2017). Osteoarthritis: care and management. Clinical Guideline CG177.