CUFC Injury Treatment Guide
The overall management of most sports injuries is based on 6 principles:
- Minimize the extent of the initial damage
- Reduce any associated pain
- Promote healing of the damaged tissue
- Maintain or restore flexibility, strength, proprioception and overall fitness during the healing phase.
- Functionally rehabilitate the injured athlete to enable return to sport
- Assess and correct any predisposing factors to reduce the likelihood of recurrence
The Soft Tissue Injury Process
The MOST important time in the treatment of soft tissue injuries is the 24 hours immediately following the injury.
Treatment should start immediately!!!
The Effects of Acute Injury
When soft tissue such as muscle, tendon or ligament is injured, blood vessels are usually torn and damaged too, which can bleed for up to 24-72 hours depending on the severity of the injury. This causes blood to accumulate around the damaged tissues and also compresses adjoined tissue and may cause further damage.
Immediately: Pain occurs as a result of damage and compression to nerve endings as well as the release of chemicals.
Subsequently: Inflammation will occur, the signs of which include:
- Reduced function
Consequently, every effort should be made to control the amount of bleeding and swelling at the site of injury.
Pain relief and protection from further damage also also required.
The most appropriate method of doing this is summarized by the letters R.I.C.E.
All injuries are to be reported to the coaching staff immediately, no matter how minor.
Rest is a valuable contributor to the healing process. The injured player should cease activity immediately following injury. Continued active movement of the injured part will result in increased bleeding and swelling.
For example, with a thigh contusion (Dead leg), bleeding will be increased by contraction of the quadriceps muscle during running. In more serious injuries, the injured part may need to be rested completely with the use of crutches for a lower limb injury or a sling for upper limb injuries.
Movements that do not produce pain at the site of injury should be performed to maintain mobility of the rest of the body.
It is important to get the correct balance between resting the injured area and early mobilization.
The application of ice immediately after injury results in reduction of pain and causes local contraction of blood vessels that narrows / decreases their diameter, thus reducing bleeding and swelling. Ice reduces the metabolic rate of tissue, thus lowering demands on oxygen & nutrients and may also decrease inflammation and muscle spasm.
Ice can be applied in a number of forms. Crushed ice can be wrapped in a moist cloth or freezer bag, placed around the injured area and held in place by a bandage. Other methods include reusable frozen gel packs and instant ice packs that do not need pre-cooling but rely on chemical reaction to provide instant cold.
Ice should be applied on the principal of 10 on 20 off for a Max. 1 hour period.
Apply Ice to the injured area for a Maximum of 10 minutes and then removed for 20 minutes.
Re-apply the ice for further 10 minute periods up to a total duration of 1 hour.
This should be done as soon as possible after the injury occurs.
There is no reason to apply ice more than six hours after you have injured yourself.
Precaution must be taken when using ice. It is important to protect the skin over the site of injury from an ‘ice burn’ by wrapping the ice in a damp towel or cloth.
Never apply heat e.g. hot bath/Deep Heat, as this will increase swelling and pain and do not apply ice to open wounds as it may cause infection.
Healing Requires Inflammation - Gabe Mirkin, MD
When you damage tissue through trauma or develop muscle soreness by exercising very intensely, you heal by using your immunity, the same biological mechanisms that you use to kill germs. This is called inflammation. When germs get into your body, your immunity sends cells and proteins into the infected area to kill the germs. When muscles and other tissues are damaged, your immunity sends the same inflammatory cells to the damaged tissue to promote healing. The response to both infection and tissue damage is the same. Inflammatory cells rush to injured tissue to start the healing process (Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999). The inflammatory cells called macrophages release a hormone called Insulin-like growth Factor (IGF-1) into the damaged tissues, which helps muscles and other injured parts to heal. However, applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1.
Ice Keeps Healing Cells from Entering Injured Tissue - Gabe Mirkin, MD
Applying ice to injured tissue causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation (Knee Surg Sports Traumatol Arthrosc, published online Feb 23, 2014). The blood vessels do not open again for many hours after the ice was applied. This decreased blood flow can cause the tissue to die from decreased blood flow and can even cause permanent nerve damage.
Anything That Reduces Inflammation Also Delays Healing
Anything that reduces your immune response will also delay muscle healing. Thus, healing is delayed by:
- cortisone-type drugs,
- almost all pain-relieving medicines, such as non-steroidal anti-inflammatory drugs like ibuprofen (Pharmaceuticals, 2010;3(5)),
- immune suppressants that are often used to treat arthritis, cancer or psoriasis,
- applying cold packs or ice, and
- anything else that blocks the immune response to injury.
Ice Also Reduces Strength, Speed, Endurance and Coordination - Gabe Mirkin, MD
Ice is often used as short-term treatment to help injured athletes get back into a game. The cooling may help to decrease pain, but it interferes with the athlete’s strength, speed, endurance and coordination (Sports Med, Nov 28, 2011). In this review, a search of the medical literature found 35 studies on the effects of cooling . Most of the studies used cooling for more than 20 minutes, and most reported that immediately after cooling, there was a decrease in strength, speed, power and agility-based running. A short re-warming period returned the strength, speed and coordination. The authors recommend that if cooling is done at all to limit swelling, it should be done for less than five minutes, followed by progressive warming prior to returning to play.
Compression offers protection & counter pressure to the injured site, reducing underlying blood flow and controlling swelling. The patients circulation should be checked at regular intervals using the ‘capillary refill test’. The players nail bed of the toes or fingers are squeezed and then released. The blood can be seen returning to the nail bed on release. The compression bandage can be worn for up to 24 hours before reapplication. It also serves to protect the injured area from further damage through immobilization.
Compression should be applied with care, as too much pressure can be harmful!!!
Any loss of sensation at the injured part should alert the player that the mode of compression is too restrictive.
The injured limb should be placed in an elevated position above the level of the heart, so that gravity can assist with the return of blood and fluid to the heart and decrease blood pressure. This reduces the opportunity for further swelling and aids the drainage of existing fluid to the general circulation via the lymphatic system. The majority of the limb should be above the level of the heart. Pain free, active (very low level) non-weight bearing movements can be performed in elevation to assist drainage by the use of a ‘muscle pump’ action.
Rhythmical movements of the uninjured joints of the body are advisable to promote blood and lymph circulation e.g. non-weight bearing foot and ankle exercises when the knee has been injured.
Anti-inflammatory medication may be taken but only when prescribed by a qualified physician.
Things to avoid in the acute stage of injury include:
- Rub/Liniment Running
- Massage (Vigorous)
Each of the factors above can increase the symptoms and severity of the injury.
Please follow the R.I.C.E. procedure to help promote healing for a Maximum of 72 hours following injury. However, if you sustain an injury, you should notify both your Coach and the Club as soon as possible.
If the injury does not begin to heal after 72 hours, please consult a qualified physician and seek professional medical advice from a registered physiotherapist.