Due to the current COVID-19 pandemic and the instructions to stay at home, many gym-goers and fitness fanatics are finding ways to ensure that they remain engaged in some form of physical activity or the other.
Even the usually sedentary folks are joining in, following the many options available especially on social media. Facebook and Instagram in particular, are currently flooded with workout videos, invitations to join group sessions, and offers for personal training.
It is fairly safe to say thousands of people are engaging in various forms and categories of exercise and fitness which include running, HIIT (high intensity interval training), Tabata, yoga, circuits, dance, gymnastics and even contact sports like boxing and kickboxing.
After all, there are constant reminders to keep fit to support your immune system and to stay healthy both mentally and physically. However, there does not seem to be much discussion on injuries, or rather the treatment of injuries, during these challenging times, whereby one may not have easy access to a doctor or physiotherapist or such.
Most people are accustomed to RICE (Rest, Ice, Compression, Elevation), and it is a method that has been commonly used by both athletes and the average joe "working out".
The RICE protocol was invented and coined by Dr Gabe Mirkin and published in 1978 in the best-selling Sports Medicine Book. It would, therefore, be a surprise to many, that the same Doctor who invented and coined the RICE protocol, has since retracted his statements. Dr Mirkin is said to have indicated that the use of ice on injuries may delay healing instead, in the book, "Iced! The Illusionary Treatment Option", Second Edition, by Gary Reinl, 2014.
In an article on his website, www.drmirkin.com, "Why Ice Delays Recovery", Dr Mirkin also states: "Coaches have used my "RICE" guideline for decades, but now it appears that both ice and complete rest may delay healing, instead of helping".
He based his statements on a study of 22 scientific articles (The American Journal of Sports Medicine, January 2004) that did not find any solid evidence that the use of ice accelerated the healing process of injuries. Dr Mirkin further cited a study in The American Journal of Sports Medicine, (June 2013) that while cooling delayed swelling, it did not speed up the recovery of damaged muscles. The argument presented is that icing prevents inflammation. However, inflammation is the first step in the healing process of tissue and muscle.
Despite the above, other studies and articles have shown positive results in the use of ice, also known as cryotherapy. The more recent protocols for treatment of injuries are PRICE (Protection, Rest, Ice, Compression, Elevation) and POLICE (Protection, Optimal Loading, Ice, Compression, Elevation). The websites www.sports-health.com and www.physio-pedia.com both share the principles and tips on how to use ice within the treatment of injuries.
Needless to say, the existing studies and research may give conflicting information on icing injuries. However, the effect on pain is not disputed. The analgesic effect of cryotherapy, whether in the form of an ice pack, a pack of frozen peas or cold water immersion, has been proven in basically all documentation. If for no other reason, using ice for an injury or muscle aches and soreness, can mean a significantly less painful experience.
Still, we would like to look at possible ways and recommended methods to treat minor injuries, aches and pains obtained from exercising (especially nowadays while at home).
The POLICE protocol is easy to understand and follow.
Protect: Aim - To protect the injured tissue from undue stress that may disrupt the healing process; How - This could include splinting or bandaging, making a sling, or using crutches. Make sure the method of protection can accommodate swelling; When and duration - Immediately and for 3-5 days depending on injury severity.
Optimal Loading: Aim - To stimulate tissue healing since too much rest can slow down recovery; How - Start simple exercises gently and carefully, then progressively work up to normal levels of strength and movement; When and duration - Rest for at least 24 hours after injury, then begin a progressive loading program until needed.
Ice: Aim - Ice helps constrict the blood vessels thereby limiting bleeding, swelling and reduces pain; How - Crushed ice wrapped in a damp towel or cloth is best; ice packs; or even a frozen pack of peas. Be sure that a cloth or towel is placed between the skin and ice; When and duration - The sooner the better. Recommended for 10-15 minutes, every 3-4 hours, for up to 72 hours. (Be careful to refrain from over-icing).
Compression: Aim - To reduce and minimize swelling; How - An elasticated bandage can work. Wrap overlapping each layer by half. Do not wrap too tightly!; When and duration- As soon as possible following injury and continue for the first 72 hours to one week.
Elevation: Aim - To lower the blood pressure to prevent swelling. Also to facilitate drainage of fluid through the lymphatic system. Ensure that the lower limb is above the level of the pelvis; How - Using pillows, footstools, slings, etc; When and duration - As soon as possible following injury and at least for the first 72 hours.
POLICE protocol adapted from "Acute Soft Tissue Injury Management Update", written by Dr Chris Bleakley, physiotherapist, and lecturer. He wrote the article based on a document published by Physios in Sport - Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSEM) in SportEX Medicine, 2013, in which the POLICE protocol was highlighted and highly recommended.
After the first 72 hours, a slow transition can be made towards using heat. Heat increases and stimulates blood flow, helps to relax muscles and provides some relief to aching joints.
The recommendations are not "one size fits all" and may need to be adjusted accordingly. Also, the very first step in case of an injury would be to speak with a doctor before attempting self-care.