Cate Matthew goes Cold Turkey, taking us inside the LOC Turkey Race Series & gives us an insight into just what an orienteering race entails!
So You Think You Might Be Injured
Tom Troughton, MSK Physio at Fara Physio
Picture this: you’re out on a fell run in the Lake District, and you’re on your final descent of the day. Your legs are heavy, your concentration is lapsing, and your once pristine, feather-light steps—worthy of Legolas the elf—now resemble something that could register on the Richter scale.
You decide to let the brakes go and open up your stride, taking the occasional risk with your landings. Suddenly, you leap down from a boulder—mid-air, twisted, and overbalanced. Your foot races towards a perfectly placed rock, and then BANG!—your right foot moves in an ungodly manner, and you collapse in a heap on the ground, searing pain shooting through your ankle.
Sound familiar? Maybe, or maybe not. Unfortunately, this was my reality two years ago while descending Hay Stacks to Buttermere after a long day on the fells.
While our short tale contains some stylistic exaggeration, most injuries don’t occur due to such traumatic events. Most injuries are overuse injuries, occurring when a runner does too much, too fast, too soon.
In this blog, we will explore what to do immediately after sustaining an injury. Please note that due to the varied and multifactorial nature of musculoskeletal injuries, these are principles and not a prescription. When in doubt, get it checked out.
RICE stands for Rest, Ice, Compression, and Elevation. This acronym has been a cornerstone of initial injury treatment since 1978
A Short History of RICE
So, you think you might be injured. What next? Crack on with RICE, right? Maybe, or maybe not. For those unfamiliar, RICE stands for Rest, Ice, Compression, and Elevation. This acronym has been a cornerstone of initial injury treatment for decades, first introduced in 1978 by Dr. Gabe Malkin (1).
RICE then evolved into PRICE (P for Protection), and 14 years later, POLICE emerged (Protection, Optimal Loading, Ice, Compression, Elevation). The introduction of Optimal Loading encouraged continued use of the injured limb to prevent deconditioning and promote a more active approach to treatment, rather than passive reliance (2)
Why the Changes?
We touched on the importance of active vs. passive recovery modalities. The new acronyms reflect this shift. Complete rest has been shown to be detrimental to recovery, potentially delaying it and slowing the return to running (4).
Notably, ice and anti-inflammatories have been removed from acute management, challenging the status quo. We’ll explore why in the next section.
In 2014, Dr. Gabe Mirkin retracted RICE due to its simplicity and emerging scientific evidence on acute injury management. Fast forward five years, and the British Journal of Sports Medicine (BJSM) introduced a new acronym in 2019: PEACE and LOVE (3).
PEACE should be used within the first few days.
- Protection: Offload or reduce movement for 1-3 days post-injury to help calm the injury, reduce bleeding, and pain. This is called relative rest. Prolonged rest is not recommended as it may weaken and tighten muscle tissue, prolonging recovery.
- Elevate: Keep the injured limb higher than the heart to enable excess fluid to flow out from the injured area.
- Avoid Anti-inflammatories: Emerging evidence suggests that the phases of inflammation help heal injured tissue, so using anti-inflammatories may delay this process. Similarly, using ice (cryotherapy) for an acute injury is also not recommended, as it may hinder healing (5).
- When we’re injured, our body releases specific hormones that promote healing by removing damaged tissue. Ice can prevent the release of these hormones, delaying recovery (5).
- However, ice may be effective in temporarily numbing pain and cooling the skin. Excessive swelling may restrict movement, increase stiffness, and thus weaken the muscle tissue due to reduced use. This study was also completed on ankle sprains, so there is still debate as to it’s wider use (6).
- So, should we completely abandon ice for acute swelling? Maybe, maybe not. If it encourages you to move the limb with less pain, then isn’t this a good thing? I think it’s a case by case basis, but the emerging evidence seems to think that ice may be better in your next cold drink on a hot summer’s day.
"All You Need is (PEACE and) LOVE" - John Lennon, 1967
- Compression: Short term use bandages or taping to reduce excessive swelling, pain, movement restriction, and promote the use of the injured limb.
- Education: Education is one of our best tools as physiotherapists. A good physio should recommend an active approach to rehabilitation. Movement should be maintained within discomfort, avoiding delayed effects and worsening pain or swelling into the next day. Use of the traffic light system by Tom Goom is a useful gauge (7)
If you see a physio who spends several weeks and most of their treatment time with you massaging your injury and doesn’t focus on the rehab, run (or hobble) a country mile to find someone who will educate you, empower you and fill you with confidence on your rehab journey.
-
L for Load: Load is the amount of stress a tissue and person is under. When you are injured, your tissue capacity reduces and thus you cannot withstand as much load. Aim to increase load slowly, listen to your body and change one thing at a time e.g. once you’re back running don’t increase hills and distance at the same time.
Load is not just limited to physical stress on the tissue, but also holistic factors, or ‘life load’ – these include low mood, poor wider health, anxiety, poor sleep, diet and support networks. Optimising as many areas as possible will help to reduce load on your body and increase your capacity to cope with this. This can be achieved through strength and mobility training, mindfulness, relaxation strategies, sleep and socialising with your club members and friends even if you’re not running. This has been found to increase pain resilience (8).
O for Optimism: Research shows that optimism during an injury is associated with improved outcomes. Psychological factors such as anxiety, depression, catastrophising (thinking the worst of a situation), and fear avoidance (not doing a movement or activity if it hurts) can amplify pain and delay healing (9).
Pain does not always mean you are harming the tissue, and the factors listed above can often ‘sensitise’ tissues, (make them more sensitive) so that the pain is amplified. In the same way, these factors can turn up the intensity of pain. Interestingly, the centres in your brain that process pain overlap with the centres that process mood and emotion (10). Therefore, optimism and resilience can improve recovery.
After the First Few Days: All you need is LOVE
V for Vascularisation: Vascularisation is the process of growing blood vessels to a tissue to improve oxygen and nutrient supply, and thus improve healing (11). Cardiovascular exercise should be a cornerstone of any rehab plan to encourage tissue healing, maintain a healthy weight, and reduce fitness loss, speeding up the return to sport.
E for Exercise: Exercise improves mobility, strength, mood, healing times, sleep, and confidence. Cross-train and focus on areas you’ve neglected, such as quads, hamstrings, calves, core, and lower back. Consider a gym membership or resistance bands and kettlebells to aid this process.
Remember, if you become injured, give your injury some PEACE and LOVE.
Conclusion
If you are injured, don’t panic. Hopefully, this blog has armed you with knowledge on what to do in the initial stages of an injury. If you’re still struggling and need advice, consult a qualified physio who can guide you on your journey from pain to performance.
At Fara Physio, we offer in-person or virtual consultations and specialise in running injuries. Drop me a message at tom@faraphysio.co.uk if you need any help—I’d be more than happy to answer any questions and guide your rehab.
Remember, if you become injured, give your injury some PEACE and LOVE.
Follow @troughtandabout on Instagram
References:
1. Mirkin, G. And Hoffman, M. (1978). The sportsmedicine book. (1st ed.) Little Brown and Co.
2. Bleakley, C.M, Glasgow, P, and MacAuley, D.C (2012). PRICE needs updating, should we call the POLICE? British Journal of Sports Medicine. (46): 220-221.
3. Dubois B, Esculier J. (2020) Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine. (54):72-73.
4. Scialoia, D & Swartzendruber, A.J (2020) The R.I.C.E Protocol is a MYTH: A Review and Recommendations (The Sport Journal)
5. Mirkin, G. (September 2015). Why Ice Delays Recovery.
https://bjsm.bmj.com/content/bjsports/54/2/72.full.pdf
6. Van den Bekerom M.P, Struijs P.A, Blankevoort L, Welling L, van Dijk C.N, Kerkhoffs G.M (2012) What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? J Athl Train. Jul-Aug;47(4):435-43.
7. Goom, T. (2021) The Traffic light system of pain https://x.com/tomgoom/status/1427348677178400772
8. Johnson, K.A., Dunbar, R. (2016) Pain tolerance predicts human social network size. Sci Rep , (6): 25267.
9. Meints SM, Mawla I, Napadow V, Kong J, Gerber J, Chan ST, Wasan AD, Kaptchuk TJ, McDonnell C, Carriere J, Rosen B, Gollub RL, Edwards RR (2019). The relationship between catastrophizing and altered pain sensitivity in patients with chronic low-back pain. Pain. 160(4):833-843.
10. Wieser, M. J., & Pauli, P. (2016). Neuroscience of pain and emotion. In M. al’Absi & M. A. Flaten (Eds.), The neuroscience of pain, stress, and emotion: Psychological and clinical implications (pp. 3–27). Elsevier Academic Press.
11. Chau L.T and Cooper-white J.J (2013) Microfluidic Devices for Biomedical Applications, 2013
Picture this: you’re out on a fell run in the Lake District, and you’re on your final descent of the day. Your legs are heavy, your concentration is lapsing, and your once pristine, feather-light steps—worthy of Legolas the elf—now resemble something that could register on the Richter scale.
You decide to let the brakes go and open up your stride, taking the occasional risk with your landings. Suddenly, you leap down from a boulder—mid-air, twisted, and overbalanced. Your foot races towards a perfectly placed rock, and then BANG!—your right foot moves in an ungodly manner, and you collapse in a heap on the ground, searing pain shooting through your ankle.
Sound familiar? Maybe, or maybe not. Unfortunately, this was my reality two years ago while descending Hay Stacks to Buttermere after a long day on the fells.
While our short tale contains some stylistic exaggeration, most injuries don’t occur due to such traumatic events. Most injuries are overuse injuries, occurring when a runner does too much, too fast, too soon.
In this blog, we will explore what to do immediately after sustaining an injury. Please note that due to the varied and multifactorial nature of musculoskeletal injuries, these are principles and not a prescription. When in doubt, get it checked out.
RICE stands for Rest, Ice, Compression, and Elevation. This acronym has been a cornerstone of initial injury treatment since 1978
A Short History of RICE
So, you think you might be injured. What next? Crack on with RICE, right? Maybe, or maybe not. For those unfamiliar, RICE stands for Rest, Ice, Compression, and Elevation. This acronym has been a cornerstone of initial injury treatment for decades, first introduced in 1978 by Dr. Gabe Malkin (1).
RICE then evolved into PRICE (P for Protection), and 14 years later, POLICE emerged (Protection, Optimal Loading, Ice, Compression, Elevation). The introduction of Optimal Loading encouraged continued use of the injured limb to prevent deconditioning and promote a more active approach to treatment, rather than passive reliance (2)
Why the Changes?
We touched on the importance of active vs. passive recovery modalities. The new acronyms reflect this shift. Complete rest has been shown to be detrimental to recovery, potentially delaying it and slowing the return to running (4).
Notably, ice and anti-inflammatories have been removed from acute management, challenging the status quo. We’ll explore why in the next section.
In 2014, Dr. Gabe Mirkin retracted RICE due to its simplicity and emerging scientific evidence on acute injury management. Fast forward five years, and the British Journal of Sports Medicine (BJSM) introduced a new acronym in 2019: PEACE and LOVE (3).
PEACE should be used within the first few days.
- Protection: Offload or reduce movement for 1-3 days post-injury to help calm the injury, reduce bleeding, and pain. This is called relative rest. Prolonged rest is not recommended as it may weaken and tighten muscle tissue, prolonging recovery.
- Elevate: Keep the injured limb higher than the heart to enable excess fluid to flow out from the injured area.
- Avoid Anti-inflammatories: Emerging evidence suggests that the phases of inflammation help heal injured tissue, so using anti-inflammatories may delay this process. Similarly, using ice (cryotherapy) for an acute injury is also not recommended, as it may hinder healing (5).
- When we’re injured, our body releases specific hormones that promote healing by removing damaged tissue. Ice can prevent the release of these hormones, delaying recovery (5).
- However, ice may be effective in temporarily numbing pain and cooling the skin. Excessive swelling may restrict movement, increase stiffness, and thus weaken the muscle tissue due to reduced use. This study was also completed on ankle sprains, so there is still debate as to it’s wider use (6).
- So, should we completely abandon ice for acute swelling? Maybe, maybe not. If it encourages you to move the limb with less pain, then isn’t this a good thing? I think it’s a case by case basis, but the emerging evidence seems to think that ice may be better in your next cold drink on a hot summer’s day.
"All You Need is (PEACE and) LOVE" - John Lennon, 1967
- Compression: Short term use bandages or taping to reduce excessive swelling, pain, movement restriction, and promote the use of the injured limb.
- Education: Education is one of our best tools as physiotherapists. A good physio should recommend an active approach to rehabilitation. Movement should be maintained within discomfort, avoiding delayed effects and worsening pain or swelling into the next day. Use of the traffic light system by Tom Goom is a useful gauge (7)
If you see a physio who spends several weeks and most of their treatment time with you massaging your injury and doesn’t focus on the rehab, run (or hobble) a country mile to find someone who will educate you, empower you and fill you with confidence on your rehab journey.
-
L for Load: Load is the amount of stress a tissue and person is under. When you are injured, your tissue capacity reduces and thus you cannot withstand as much load. Aim to increase load slowly, listen to your body and change one thing at a time e.g. once you’re back running don’t increase hills and distance at the same time.
Load is not just limited to physical stress on the tissue, but also holistic factors, or ‘life load’ – these include low mood, poor wider health, anxiety, poor sleep, diet and support networks. Optimising as many areas as possible will help to reduce load on your body and increase your capacity to cope with this. This can be achieved through strength and mobility training, mindfulness, relaxation strategies, sleep and socialising with your club members and friends even if you’re not running. This has been found to increase pain resilience (8).
O for Optimism: Research shows that optimism during an injury is associated with improved outcomes. Psychological factors such as anxiety, depression, catastrophising (thinking the worst of a situation), and fear avoidance (not doing a movement or activity if it hurts) can amplify pain and delay healing (9).
Pain does not always mean you are harming the tissue, and the factors listed above can often ‘sensitise’ tissues, (make them more sensitive) so that the pain is amplified. In the same way, these factors can turn up the intensity of pain. Interestingly, the centres in your brain that process pain overlap with the centres that process mood and emotion (10). Therefore, optimism and resilience can improve recovery.
After the First Few Days: All you need is LOVE
V for Vascularisation: Vascularisation is the process of growing blood vessels to a tissue to improve oxygen and nutrient supply, and thus improve healing (11). Cardiovascular exercise should be a cornerstone of any rehab plan to encourage tissue healing, maintain a healthy weight, and reduce fitness loss, speeding up the return to sport.
E for Exercise: Exercise improves mobility, strength, mood, healing times, sleep, and confidence. Cross-train and focus on areas you’ve neglected, such as quads, hamstrings, calves, core, and lower back. Consider a gym membership or resistance bands and kettlebells to aid this process.
Remember, if you become injured, give your injury some PEACE and LOVE.
Conclusion
If you are injured, don’t panic. Hopefully, this blog has armed you with knowledge on what to do in the initial stages of an injury. If you’re still struggling and need advice, consult a qualified physio who can guide you on your journey from pain to performance.
At Fara Physio, we offer in-person or virtual consultations and specialise in running injuries. Drop me a message at tom@faraphysio.co.uk if you need any help—I’d be more than happy to answer any questions and guide your rehab.
Remember, if you become injured, give your injury some PEACE and LOVE.
Follow @troughtandabout on Instagram
References:
1. Mirkin, G. And Hoffman, M. (1978). The sportsmedicine book. (1st ed.) Little Brown and Co.
2. Bleakley, C.M, Glasgow, P, and MacAuley, D.C (2012). PRICE needs updating, should we call the POLICE? British Journal of Sports Medicine. (46): 220-221.
3. Dubois B, Esculier J. (2020) Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine. (54):72-73.
4. Scialoia, D & Swartzendruber, A.J (2020) The R.I.C.E Protocol is a MYTH: A Review and Recommendations (The Sport Journal)
5. Mirkin, G. (September 2015). Why Ice Delays Recovery.
https://bjsm.bmj.com/content/bjsports/54/2/72.full.pdf
6. Van den Bekerom M.P, Struijs P.A, Blankevoort L, Welling L, van Dijk C.N, Kerkhoffs G.M (2012) What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? J Athl Train. Jul-Aug;47(4):435-43.
7. Goom, T. (2021) The Traffic light system of pain https://x.com/tomgoom/status/1427348677178400772
8. Johnson, K.A., Dunbar, R. (2016) Pain tolerance predicts human social network size. Sci Rep , (6): 25267.
9. Meints SM, Mawla I, Napadow V, Kong J, Gerber J, Chan ST, Wasan AD, Kaptchuk TJ, McDonnell C, Carriere J, Rosen B, Gollub RL, Edwards RR (2019). The relationship between catastrophizing and altered pain sensitivity in patients with chronic low-back pain. Pain. 160(4):833-843.
10. Wieser, M. J., & Pauli, P. (2016). Neuroscience of pain and emotion. In M. al’Absi & M. A. Flaten (Eds.), The neuroscience of pain, stress, and emotion: Psychological and clinical implications (pp. 3–27). Elsevier Academic Press.
11. Chau L.T and Cooper-white J.J (2013) Microfluidic Devices for Biomedical Applications, 2013
Tom works as a Physiotherapist and freelance photographer & videographer.
Tom founded Trought and About (@troughtandabout) with his wife Essi in September 2021. The idea started when friends repeatedly asked for routes of where to go for hikes, trail runs or mountain bike rides.
Over time, a passion for outdoor photography, videography and content creation was born. With backgrounds in healthcare, they also hope to inspire others to get outdoors to improve physical, mental and social wellbeing.
Tom works as a Physiotherapist and freelance photographer & videographer.
Tom founded Trought and About (@troughtandabout) with his wife Essi in September 2021. The idea started when friends repeatedly asked for routes of where to go for hikes, trail runs or mountain bike rides.
Over time, a passion for outdoor photography, videography and content creation was born. With backgrounds in healthcare, they also hope to inspire others to get outdoors to improve physical, mental and social wellbeing.
If you have a story to tell, whether it’s from the OMM, another race or challenge or just how you use our kit, get in touch! Just pop an email to james@team-ark.com and who knows, you might just earn yourself some free kit!
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