Strained or ‘pulled’ muscles often happen when we overexert untrained muscles, train without properly warming up or try to go beyond a joint’s natural flexibility. Sometimes we feel the pain straight away, however some injuries might not cause pain until later. What can you do?

If the pain or swelling fails to improve within a week, booking an appointment may be beneficial. we will be able to assess and advise you on the correct treatment and can provide some manual therapy which may help it get better faster.

The P.O.L.I.C.E. Principle may be the new approach to your acute injury treatment. It can help guide you in the proper way to use ice and gentle motion to quickly get back to your normal activities.

For many years, physical therapists, as well as athletic trainers, doctors, and sports medicine specialists have recommended the R.I.C.E. principle to manage acute injuries. The acronym stands for Rest, Ice, Compression, and Elevation.

If you have suffered an injury, like a sprained ankle, your healthcare practitioner would likely recommend treating it initially using the R.I.C.E. acronym. First, rest the injured area. Then apply some ice to your injury using some form of compression (like an ACE bandage) and elevate the injured body part.

The thought process behind this is that in the initial days following injury, your body brings a lot of blood and fluid to the injured site to prepare it for healing, but your body may bring too much fluid to the injured area. This excessive fluid limits range of motion (ROM) around your joint and can actually delay proper healing.

What's Wrong with R.I.C.E.

While the R.I.C.E. technique makes sense, there are a couple problems with it. First, it hasn't really been proven to work like we think it works. One study published in the Journal of Athletic Training found that there is a lack of solid evidence that the R.I.C.E. treatment for ankle sprains leads to better outcomes after the injury. Some experts believe that ice applied initially after an injury impedes the normal healing process.

Another problem with the R.I.C.E. technique is that many people take the "rest" phase a little too far. Often after acute injury, a little bit of rest is necessary. But you may feel compelled to rest your injured muscle or joint for far longer than is necessary. A long period of immobilization can lead to decreased muscle strength and flexibility. This may delay your return to normal functional mobility and activity.

What Does P.O.L.I.C.E. Stand For?

So is there another action to take after a sudden injury like a ligament sprain or muscle strain? Some physical therapists are recommending the P.O.L.I.C.E. principle. The P.O.L.I.C.E. acronym is as follows:

  • Protection: During the first few days after an injury, you should certainly rest the injured joint, ligament, or muscle. After a few days, gentle motion can be started while you still maintain a level of protection for the injured area. During this time you may require some sort of assistive device, like crutches, to walk.

  • Optimum Loading: While you are protecting your injured body part, gentle motion can, and should, be started. For example, after a shoulder injury or shoulder surgery, you should be able to progress from a few days of rest to passive ROM, active ROM, and finally, rotator cuff strengthening exercises. This progressive loading of your injury can help promote optimal healing of the injury and it can prevent delays in returning to normal due to joint and muscle tightness or muscle atrophy.

  • Ice: Applying ice may help to manage the swelling around your injured muscle or joint, and ice can help decrease some of the acute pain that you may be experiencing. Your PT can help you determine the best method of applying an ice to your injury. He or she can also teach you how to make your own ice pack.

  • Compression: While applying ice, compression can be added using an ACE bandage. You can also use a product like Ice Tape to cool and compress the injury at the same time.

  • Elevation: Elevation is simple for some body parts. An injured ankle or knee can be placed on a stack of pillows while you are lying down. An injury to your elbow or wrist requires that you elevate your entire arm on something. Your PT can help advise you on the best way to elevate your injury.

As you can see, the P.O.L.I.C.E. principle deviates slightly from the R.I.C.E. method. Sure, ice is still used, but there no rest component. Rather, optimal loading and movement are used. This creates early motion, decreases stiffness, and may help you quickly get moving again

Seek medical attention, if you have pain that can’t be controlled with over the counter painkillers, you can’t put weight on the injured limb, experience paralysis or loss of sensation or the swelling is very bad. You can seek help from your local A&E department, urgent care centre or telephone 111 for advice.

Here is the example of the older R.I.C.E method.

RICE Method (Relative rest, Ice, Compression and Elevation), using these can help to relieve the pain and start the healing process.

Relative rest: The first thing to do if you feel pain is to reduce the offending activity – pain is usually your body’s way of telling you that there is something wrong that needs your attention. It can be normal to feel a little sore after exercises for a day or two, but if it is more than this, pushing through the pain is rarely beneficial.

However, movement stimulates the healing process so stay as mobile as you comfortably can. Try to keep the joint moving through a comfortable range of motion, without forcing it to the point of pain. This will help to encourage blood flow and keep your joint flexible whilst it heals. This is particularly relevant for back pain as gentle exercise, such as walking, can help. You should slowly build your activity levels up as soon as your symptoms begin to resolve and as soon as you are able.

Ice: Cooling the area using an ice pack can help to reduce swelling and pain. Wrap a thin tea towel around the area so as to avoid direct skin contact and then apply the pack to the injured area for 10 – 15 minutes. You should repeat this several times per day for the first 72 hours. This will help to control inflammation, making it easier for your body to get blood and nutrients to the area and resolve the injured tissues.

Compression: Gently applying a compression dressing may help to temporarily support the injured joint and reduce swelling, though remove this immediately if there are signs that this is reducing the circulation to the area (numbness, pins and needles, the skin turning white or blue etc).

Elevation: If the injury is in the lower limb (knee or ankle), elevating the area a little can make it easier for your body drain fluids that might accumulate around the area, causing swelling. For example, if you’ve hurt your knee, sitting down with the knee raised on a low foot stool may ease your pain.