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loading in acute soft tissue injury man-

PRICE needs updating, agement. Optimal loading is an umbrella
term for any mechanotherapy interven-
tion and includes a wide range of manual
should we call the POLICE? techniques currently available; indeed
the term may include manual techniques
C M Bleakley,1,3 P Glasgow,2,3 D C MacAuley4 such as massage rened to maximise the
mechano-effect. Paradoxically, crutches,
braces and supports, traditionally associ-
The acronym PRICE (protection, adverse changes to tissue biomechanics ated with rest, may have a greater role in
rest, ice, compression and eleva- and morphology. Progressive mechani- adjusting and regulating optimal loading
tion) has been central to acute cal loading is more likely to restore the in the early stages of rehabilitation.
soft tissue injury management strength and morphological characteris- POLICE should make us think more
for many years despite a pau- tics of collagenous tissue.4 5 Indeed, early about research into designing rehabilita-
city of high-quality, empirical mobilisation with accelerated rehabilita- tion strategies that are appropriate to the
evidence to support the various compo- tion is effective after acute ankle strain.7 nature and severity of injury in different
nents or as a collective treatment package. Functional rehabilitation of ankle sprain, sports and activities. If the primary princi-
Treatment paradigms in sports medicine which involves early weight-bearing usu- ple of treatment is to restore the histologi-
must be updated based on contemporary ally with an external support, is superior cal and mechanical properties of injured
research evidence. As a recent example, to cast immobilisation for most types of soft tissue, optimal loading may indeed
the widespread use of non-steroidal anti- sprain severity.8 9 be sport specic. The challenge is in deter-
inammatory drugs in acute soft tissue Functional rehabilitation aligns well mining what is optimal in terms of the
injury management has been challenged, with the principles of mechanotherapy, dosage, nature and timing.
particularly with ligament and muscle in- whereby mechanical loading prompts POLICE is not just an acronym to guide
juries.1 cellular responses that promote tissue management but a stimulus to a new eld
Ice compression and elevation (ICE) structural change.10 There are consistent of research. It is important that this research
is the basic principle of early treatment. ndings from animal models that dem- includes more rigorous examination of the
Most research has focused on the anal- onstrate how mechanical loading upregu- role of ICE in acute injury management.
gesic effect of icing or the associated skin lates mRNA expression for key proteins Currently, cold-induced analgesia and the
or intramuscular temperature changes; associated with soft tissue healing.46 The assurance and support provided by com-
a recent randomised controlled trial by difcult clinical challenge is nding the pression and elevation are enough to retain
Prins and colleagues,2 which examined balance between loading and unloading ICE within the acronym.
the effectiveness of ice on recovery from during tissue healing. If tissues are stressed
Competing interests None.
acute muscle tear, is the rst of its kind. too aggressively after injury, the mechani-
Clinical studies into compression are cal insult may cause re-bleeding or further Provenance and peer review Not commissioned;
externally peer reviewed.
also lacking, and much of its rationale is damage. Protection of vulnerable tissues
extrapolated from research relating to therefore remains an important principle. Accepted 3 August 2011
deep venous thrombosis prophylaxis and But, too much emphasis creates a default Published Online First 7 September 2011
lymphoedema management; there is little mindset that loading has no place in acute Br J Sports Med 2012;46:220221.
clinical research on elevation.3 management. Rest may be harmful and doi:10.1136/bjsports-2011-090297
Protection and rest after injury are sup- inhibits recovery. The secret is to nd the
ported by interventions that stress shield, optimal loading. REFERENCES
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the Management of Acute Soft Tissue Injury Using
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University of Ulster, Jordanstown, Newtownabbey, UK
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Queens University Belfast, Royal Victoria Hospital, during wound healing and hindlimb unloading.
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Br J Sports Med March 2012 Vol 46 No 4 221

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PRICE needs updating, should we call the

C M Bleakley, P Glasgow and D C MacAuley

Br J Sports Med 2012 46: 220-221 originally published online September

7, 2011
doi: 10.1136/bjsports-2011-090297

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