The P.R.I.C.E. is Right for Exercise Injuries

It’s ironic that I wrote about exercise injuries in last week’s column because over the weekend my old shoulder injury paid me a visit. I was trying out a new exercise technique that requires a lot of rotary arm movement. In my excitement of learning a new skill I forgot that my left shoulder would be vulnerable to the large range of motion it was being put through.

Within fifteen minutes I began to feel a familiar twinge of pain in my shoulder joint. Being older, wiser, and smarter, I listened to the warning signals my body was sending me and immediately used some of the techniques in the P.R.I.C.E. protocol. Thus, my old injury had just enough time to say hello and good-bye.

P.R.I.C.E. is an acronym that stands for protect, rest, ice, compress, and elevate. It is used as a first-aid measure mostly for acute injuries but chronic injuries can also benefit. An acute injury develops suddenly like a sprained ankle, while chronic injuries develop over time. Most exercise injuries are the chronic type. They start out as mild aches and pains but gradually get worse if ignored.

Pain is the body’s number one warning that something is wrong. It is most often caused by inflammation and swelling at the site of injury. This can happen suddenly like the rapid pain and swelling of a sprained ankle or it can take place gradually over a period. An example would be feeling slight pain in the knees the day after doing step aerobics or spinning, then feeling the pain right after the workout, then feeling it during the exercise session, and eventually your knees are painful even when you are not working out.

In any case, inflammation is just the body’s natural response to the injury. Here is an explanation of the process from the book “Athletic Forever” by Dr. Frank Jobe of the Kerlan-Jobe Orthopedic Clinic. “The brain treats the inflammation like an infection (even though it is not). In doing so, the body attempts to ‘quarantine’ the injured area by sending in small blood borne cells called platelets. The function of platelets is to clot or slow down blood flow. The brain also sends white blood cells to fight infection and histamine, which actually causes cells in the area to leak their fluid into the spaces between the cells causing even more excess fluid in the area. All of this excess fluid and cellular material dramatically block normal blood flow, resulting in pain. In the very early stages of an injury, the inflammation process helps stop bleeding of the injured tissue, so it’s helpful. When inflammation persists, however, the problem is that it can ultimately interfere with movement and healing”.

According to Jobe, your main enemy in the hours following an acute injury is inflammation. “The more swelling occurs, the more affected your tissue will be and the longer it will take to get back to full strength”. That’s why it’s important to start the P.R.I.C.E. regimen at once.

Protect the injured area from further damage by immediately ceasing the offending activity. Much as I wanted to continue trying out the new exercise routine, I took the more sensible route and stopped doing it. Then, I protected my shoulder even more by not sleeping on it for two nights. In the case of a sprained ankle, protect the joint by using crutches or any other means to avoid putting weight on it.

The rest component of the PRICE protocol seems self-explanatory. Let your injured joint or muscle rest while the pain and swelling goes down. But this doesn’t mean that you can’t exercise the other parts of your body that are not injured. My shoulder may have been hurting me but I still did brisk walking, did ab crunches, and worked on my legs with rubber tubing.

Jobe writes, “Icing an injury constricts the blood vessels, which serves a dual purpose: it minimizes pain and may reduce inflammation, particularly when used immediately following the injury. Ice should be applied as soon as possible after the injury has occurred, held there for 20 minutes, and reapplied three or four times a day for the first 48 hours. Don’t apply heat during the first 48 hours, and don’t massage the injury. Both will increase the flow of fluids that contribute to inflammation.”

Jobe recommends following these guidelines when applying ice:

· Use crushed ice or small ice cubes that can conform to the shape of the injury. A bag of frozen vegetables such as peas or corn also works well.
· Wrap the ice in plastic.
· Place a towel over the skin to prevent the skin from freezing.
· Use an elastic bandage or athletic tape to tie the ice compress over the affected area.

Keep the injury wrapped with a compression bandage to further prevent swelling. Jobe says athletic tape provides the best, most form-fitting compression but since it is difficult to apply yourself without training or practice, only a professional should apply it. His next best recommendation is an elastic bandage and his third option is a Neoprene sleeve. My shoulder was not injured enough to need compression.

Injuries in the legs need to be kept elevated above waist level to reduce swelling. Keep the injured leg elevated even while sleeping.

Heat versus Ice
Jobe explains that heat and ice are both helpful in healing injuries but they work in very different ways. “Ice increases blood flow by initially slowing blood flow and constricting the blood vessels. Your brain then perceives that area of the body as cold, and sends more blood there to warm it up. The first few days following an injury, ice can be extremely helpful for reducing swelling.”

“Heat increases blood flow by opening up (dilating) the blood vessels. It can be used beginning 48 to 72 hours after an acute injury. If used earlier, it may increase swelling and inflammation. After two or three days, both heat and ice can be used. Alternating ice with heat (called contrast baths) can have the effect of flushing stale inflammatory fluids from the area and bringing in nutrient-rich fluids.”

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