Acute Sports Injury Treatment using the P.R.I.C.E. Principle
Hundreds of athletes sustain acute injuries everyday while participating in sports. An acute sports injury is one in which there is a specific mechanism of injury (hit by ball, plant and twist, collision with opponent) and an immediate onset of symptoms including swelling, pain, bleeding, and possible deformity.
A number of types of sports injuries can be considered acute including:
• Sprains (injury to ligaments)
• Strains (injury to muscles)
• Contusions (bruise)
• Subluxation (partial dislocation that reduces itself)
If there are signs or symptoms of a serious injury (deformity, severe swelling and/or pain), emergency first aid should be provided while keeping the athlete calm and still until emergency service personnel arrive on scene.
However, most acute sports injuries can be treated safely at home using the P.R.I.C.E. principle. The acronym stands for:
• Protection• Rest
The principles of P.R.I.C.E. should be used for the first 48 – 72 hours immediately after the injury. The goal during this time frame is to control the amount of swelling to the injured area, prevent further injury, and reduce pain. Following these principles can effectively reduce the amount of swelling in an injured area thereby reducing the amount of time required for rehabilitation.
The first principle is protection. The purpose of protection is to avoid further injury to the area by protecting the injured structures. The type of protection used varies depending on the injured area but may include an ace bandage, aluminum splint, sling, protective tape, or over-the-counter brace.
These devices are applied so that the injured structures are protected from further injury. For example, an individual who recently suffered an ankle sprain may initially wear an ankle brace. A good ankle brace should protect the athlete from movements of inversion (movement of the ankle/foot inwards) and eversion (movement of the ankle/foot outwards) because those movements could further injure the damaged ligaments, but would allow the ankle/foot to move up and down.
Rest is the second component of the P.R.I.C.E. principle. The purpose of resting is to allow the body’s own healing processes to naturally occur without being impeded by movement of the injured area. Any increase in movement of an injured tissue results in increased circulation to the area which in turn may result in further damage to the injured tissue and/or increased swelling.
For injuries to the lower extremities, crutches may be a good option for resting the injured area. If an athlete is in enough pain to have a noticeable limp, the athlete should be placed on crutches. The crutches provide a safe means for the athlete to move around while ensuring that the damaged area is not stressed.
Athletes can either be non-weight bearing on crutches (injured leg is bent with full weight of athlete on crutches and uninjured leg while walking) or partial-weight bearing (partial weight is placed on injured leg). Athletes may use a combination of these two gaits starting with non-weight bearing for the first 48hours and then moving to a partial-weight bearing gait.
Ice is another component of the P.R.I.C.E. principle. There are a number of types of cryotherapy that can be used effectively to treat injuries. The most common is an ice pack.
Ideally, ice packs are made of crushed ice because the crushed ice is more comfortable for the athletes and conforms to the contours of the injured area better than cubed ice. Ice can be placed into plastic or Ziploc bags. A light barrier should be placed between the skin and the ice bag (paper towel) to prevent injury to the skin during the application of the ice.
The ice pack can be secured with an ace bandage if needed. The ice should be applied for 20 minutes at a time and then removed. This can be repeated every two hours while the athlete is awake.
Some athletes are hypersensitive to ice or may actually be allergic to ice. In this case, the athlete’s skin may become red, raised, and blotchy where the ice made contact with the skin. If this occurs, immediately remove the ice pack and let the area rewarm.
When the ice pack is removed, a compression wrap should be applied to the injured area. The compression wrap serves as a mechanical barrier so that swelling is minimized in the injured area. There are a number of compression wraps available on the market, but the most commonly used is an elastic or ace bandage.
Elastic bandages come in a number of sizes (2”, 3”, 4”, and 6”) and should be selected depending upon the body part that needs to be wrapped. A two inch elastic bandage is ideal for an adult’s wrist/hand or a child’s ankle.
Three and four inch elastic bandages can be used for an adult’s ankle or elbow. Six inch elastic bandages are perfect for the application of compression to the thigh for a quadriceps or hamstring injury.
To wrap the knee, groin, or shoulder area, the preferred elastic bandage is a double length elastic bandage. This double-length wrap can be purchased in four and six inch widths.
The last component of the P.R.I.C.E. principle is elevation. Elevation is important immediately post-injury to reduce the amount of blood flow to the injured area. For the lower extremities, the athlete can elevate his/her leg by lying down and elevating the injured limb on pillows. The key is that the athlete needs to have the injured area above his/her heart level.
Following the PRICE principles is an effective way to minimize the swelling in an injured area so that the athlete can return to play quickly.
Anderson, M., Hall, S. & Martin, M. (2000). Sports Injury Management. (2nd Ed.). Lippincott Williams & Wilkins: Philadelphia, PA.
Bahr, R. & Maehlum, S. (2004). Clinical Guide to Sports Injuries. Human Kinetics: Champaign, IL.