Acute sprains, muscle strains and bruises are some examples of musculoskeletal injuries that are commonly encountered. How you deal with an injury in the first few days after the trauma can have a huge impact on the healing process that follows. Acronyms have been offered to help us decide which approach to take and these have evolved over the years from ICE to RICE, then to PRICE (see meaning at bottom of article). In 2012, an author from the United Kingdom introduced a new idea with his acronym POLICE: “PRICE needs updating, should we call the POLICE? “. In 2017, the acronym was subsequently added to new letters: POLICE-CANAI.
In April 2019, the acronym was corrected in light of scientific advances in the field. Indeed, a Quebec update was presented to the international scientific community with a publication in the British Journal of Sports Medicine (BJSM). The time had come to be a little more rigorous in the management of acute musculoskeletal injuries. One of the main changes was to remove the “I” (For ICE). The psychological factor has also been added and the negative effect of hypermedicalization is now taken into account. Finally, the steps are presented to us in their order of application.
PEACE & LOVE
Immediately after soft tissue injury, do no harm and let PEACE guide your approach.
- P = Protection (avoid painful activities in the first few days)
- E = Elevation (raise the affected limb as often as possible so that it is higher than the heart)
- A = Anti-inflammatory to be avoided (avoid anti-inflammatory drugs and ice as much as possible)
- C = Compression (apply an elastic bandage or ideally a compression taping to reduce initial swelling)
- E = Education (learn the best management practices)
After the first few days, the soft tissues need LOVE.
- L = Load (progression of loading and movement without pain)
- O = Optimism (be confident and positive about your recovery)
- V = Vascularization (the damaged tissue must be vascularized and metabolism must be increased by the practice of cardiovascular activities)
- E = Exercises (to promote active rehabilitation)
For the curious, here are the “old” acronyms:
P / R / ICE
- P = Protection (make sure not to cause pain the first few days)
- R = Rest or Activity Reduction (often misinterpreted as a cessation of activity)
- I = Ice (apply ice pack 15 minutes during the first 2 to 3 days (every 1 to 2 hours))
- C = Compression (apply elastic bandage or ideally taping to reduce initial swelling)
- E = Elevation (raise the affected limb as often as possible so that it is higher than the heart)
POLICE (2012)
- P = Protection (make sure not to cause pain during the first few days)
- O L = Optimal Loading (quantify its mechanical stress by quickly integrating loading and movement without pain)
- I = Ice (apply ice pack 15 minutes during the first 2 to 3 days (every 1 to 2 hours))
- C = Compression (apply elastic bandage or ideally taping to reduce initial swelling)
- E = Elevation (raise the affected limb as often as possible so that it is higher than the heart)
POLICE-CANAI
- C A = Cardiovascular activity (from the third day, in order to accelerate healing, it is desirable that the damaged tissue is vascularized and its metabolism increased)
- N A I = No Anti-inflammatory (avoid anti-inflammatory drugs that slow the healing of damaged tissues)
Thank you to our Quebec physiotherapist colleagues for their involvement in the scientific community on the subject.
- Blaise Dubois is the president and founder of The Running Clinic, an organization providing continuing education internationally. In the clinic and in research, Blaise is interested in the prevention and treatment of running injuries, with a particular focus on footwear and bio-mechanics. (Quebec City, Canada).
- Jean-Francois Esculier combines clinical research (Department of Physical Therapy, University of British Columbia) with patient care (Kelowna, British Columbia) and knowledge translation (The Running Clinic, Canada). He loves to educate and empower patients so they can become the main actor of their rehabilitation.
