One of the most common questions we get from our patients is, “Do I need to take anti-inflammatory medications? Are they helpful or harmful?”
It’s no secret that anti-inflammatory medications can be a lifesaver when you’re in pain. On several occasions use of anti-inflammatory medications is indicated and important to enable normal function. But the current literature shows that they could also be hurting your long-term soft tissue regeneration?
If you’re looking to heal after a soft tissue injury, it’s important to understand that the inflammatory process is important for optimal tissue regeneration and current evidence shows that anti-inflammatory medications may negatively affect long-term tissue healing.
The inflammatory process is an essential part of the healing process that involves different types of cells and chemical mediators, which work together in sequence to achieve healing. It’s during this phase that immune cells are recruited to the site of injury, which helps prevent infection and remove dead cells and debris from the area. This is also when new blood vessels form to supply oxygen and nutrients to damaged tissues that are vital to repair and rebuild the injured tissues — which means using medications to inhibit inflammation could impair tissue healing.
What about applying ice to the part?
So how does ice work? Ice can numb pain by affecting the temperature of your skin and underlying tissue, which reduces nerve impulses sent to your brain. It also numbs muscle tissue so that you don’t feel as much pain when moving around after an injury.
However, while applying ice or cold modalities is widely accepted an intervention for reducing pain and swelling, there’s very little high-quality evidence that supports the use of ice in the treatment of soft tissue injuries. Further, Ice may potentially disrupt inflammation, angiogenesis and revascularisation—meaning it could potentially interfere with your body’s ability to heal.
So, what do I do?
The current consensus for management following a minor injury is listed in the tabular column below. Please consult your medical doctor or a registered health professional for complete assessment and appropriate management of your injury and pain.
P | PROTECTION
| Avoid activities that increase pain for the first few days after injury. |
E | ELEVATION
| Elevate the injured limb higher than the heart as often as possible. |
A | AVOID ANTI-INFLAMMATORIES | Avoid taking anti-inflammatory medications as they reduce tissue healing. If possible, avoid icing as well. |
C | COMPRESSION | Use elastic bandage or taping to reduce swelling. Kinesiology taping has demonstrated effectiveness in improving sub-cutaneous lymphatic flow thus facilitating healing in the acute phase. |
E | EDUCATION | Identifying the underlying cause of pain would eliminate unnecessary fear. Consulting an appropriate medical professional such as a physiotherapist or a regulated health professional would help to identify the underlying cause of pain and would also help to fast-track post-injury rehab. |
& | ||
L | LOADING | Appropriate loading is important after an injury. Often times people tend to return their pre-injury level of activities immediately, while this may not pose a problem in low-level loading, it would certainly increase the risk of re-injury in higher level activities. |
O | OPTIMISM | A positive attitude towards recovery and rehab will certainly go a long way in returning to full activities after an injury. This would come with having adequate knowledge on the underlying injury, setting short term and long-term goals to pursue and a plan of action to accomplish that. |
V | VASCULARISATION | Adequate circulation – blood flow and lymphatic circulation to the affected part is important in the healing process. Appropriate interventions with exercises, Kinesiotaping and/or bracing would help to accomplish that. |
E | EXERCISES | This is by far the most important component of rehab. Exercises enables us to load the part in a controlled environment and prepare for the activities. We are able to control the frequency, intensity, time and type of loading with exercises. |
References:
- Dubois B, Esculier J. Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine 2020;54:72-73.
- ↑Bleakley CM, Davison G. Management of acute soft tissue injury using protection rest ice compression and elevation: recommendations from the Association of Chartered Physiotherapists in sports and exercise medicine (ACPSM)[executive summary]. Association of Chartered Physiotherapists in Sports and Exercise Medicine. 2010:1-24.
- ↑ Jump up to:03.1 3.2 Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE? British Journal of Sports Medicine 2012;46:220-221.
- ↑ Jump up to:04.1 4.2 Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. British journal of sports medicine. 2017 Jan 1;51(2):113-25.
- ↑ Jump up to:05.1 5.2 Vuurberg G, Hoorntje A, Wink LM, Van Der Doelen BF, Van Den Bekerom MP, Dekker R, Van Dijk CN, Krips R, Loogman MC, Ridderikhof ML, Smithuis FF. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British journal of sports medicine. 2018 Aug 1;52(15):956-.
- ↑Duchesne E, Dufresne SS, Dumont NA. Impact of inflammation and anti-inflammatory modalities on skeletal muscle healing: from fundamental research to the clinic. Physical therapy. 2017 Aug 1;97(8):807-17.
- ↑van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, Van Dijk CN, Kerkhoffs GM. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?. Journal of athletic training. 2012 Jul;47(4):435-43.
- ↑Singh DP, Barani Lonbani Z, Woodruff MA, Parker TJ, Steck R, Peake JM. Effects of topical icing on inflammation, angiogenesis, revascularization, and myofiber regeneration in skeletal muscle following contusion injury. Frontiers in physiology. 2017 Mar 7;8:93.
- ↑Lewis J, O’Sullivan P. Is it time to reframe how we care for people with non-traumatic musculoskeletal pain?British Journal of Sports Medicine 2018;52:1543-1544.
- ↑Graves JM, Fulton‐Kehoe D, Jarvik JG, Franklin GM. Health care utilization and costs associated with adherence to clinical practice guidelines for early magnetic resonance imaging among workers with acute occupational low back pain. Health services research. 2014 Apr;49(2):645-65.
- ↑ Jump up to:011.1 Khan KM, Scott A. Mechanotherapy: How physical therapists’ prescription of exercise promotes tissue repair. British journal of sports medicine. 2009 Apr 1;43(4):247-52.
- ↑ Jump up to:012.1 Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, Straker L, Maher CG, O’Sullivan PP. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. British journal of sports medicine. 2020 Jan 1;54(2):79-86.
- ↑Briet JP, Houwert RM, Hageman MG, Hietbrink F, Ring DC, Verleisdonk EJ. Factors associated with pain intensity and physical limitations after lateral ankle sprains. 2016 Nov 1;47(11):2565-9.
- ↑Bialosky JE, Bishop MD, Cleland JA. Individual expectation: an overlooked, but pertinent, factor in the treatment of individuals experiencing musculoskeletal pain. Physical therapy. 2010 Sep 1;90(9):1345-55.
- ↑Bleakley CM, O’Connor SR, Tully MA, Rocke LG, MacAuley DC, Bradbury I, Keegan S, McDonough SM. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. Bmj. 2010 May 10;340.
- Physiopedia (2022, Jul 4) https://www.physiopedia.com/Peace_and_Love_Principl