Sport is a dynamic, highly physical game that incorporates repeated sprint intervals, frequent rapid changes of direction, and many twists and turns. As such, soft tissue injuries are relatively common, and something that most players will have to deal with at one time or another. In this article, we’ll take a look at how best you can treat these typical kinds of sprains and strains.
There are several common pneumonics that have been used in regards to minor/moderate musculoskeletal injuries. These include R.I.C.E. (Rest Ice Compression Elevation), which was subsequently amended to M.I.C.E. (Movement Ice Compression Elevation) to take into account the proposed value of keeping injured areas mobile where possible.
Further to these though, the P.O.L.I.C.E. principle is the more modern, modified first aid method of treating acute musculoskeletal injuries. POLICE stands for Protect, Optimal Loading, Ice, Compression, and Elevation. It promotes and guides safe and effective loading in soft tissue injury management, and can help you better address and recover from minor muscle and joint issues the like of which are so common in squash.
Protect
Protect emphasizes the importance of avoiding further tissue damage, but doesn’t infer indefinite immobilization. This could mean using crutches to protect an injured lower extremity, or putting an injured shoulder into a sling, while still being able to actively engage in daily tasks working around these issues. Being careful not to aggravate your injury by physically stressing it unnecessarily, is the first stage in injury management and recovery.
Optimal Loading
Optimal loading will help promote the healing process as bone, tendon, ligament, and muscle all require some loading to stimulate healing. The crutches, braces, supports etc used in the ‘protect’ stage, also hold value in adjusting and regulating loading as you move into the early stages of rehabilitation.
The right amount of activity can also help to manage oedema (swelling). For example in the ankle, contraction of the calf muscles can help to move swelling up the body against gravity, while complete rest would prevent this. In some instances of course, loading may not be appropriate (e.g. severe fractures requiring surgery).
If you don’t have a physio to guide you, you should aim to gradually increase the load on the injured area progressively over the initial days and weeks after the injury, working just to the point of onset of slight pain but no further. Basic weight bearing exercise such as walking and light jogging should be slowly introduced as pain allows, in conjunction with targeted strengthening exercises beginning with just bodyweight, and progressing to low weights/resistances.
Ice
Ice therapy (or ‘cryotherapy’), reduces tissue metabolism and causes blood vessel constriction. This physiological change helps slow and prevent further swelling – an important consideration for early active ROM exercises after the initial period of rest. Ice can also help reduce pain and muscle spasms, alleviating some of the discomfort associated with many sports injuries.
However, applying cryotherapy for an extended period of time can actually be detrimental to the healing process. Damage can be worsened if blood flow is excessively reduced, and the risk of skin burns and nerve damage increases with prolonged ice application. There is some debate surrounding appropriate dosage for cryotherapy in acute injury, however most experts suggest that two to three 10-minute ice treatments interspersed with 10-minute periods without ice are most effective, repeated every couple of hours.
Keep in mind also that there is no optimal dosage that will be ideal for all body locations, and if in doubt you should always seek professional advice. In the majority of cases, it is recommended that the ice is wrapped in a damp towel or cloth to minimise the risk of superficial nerve or skin damage.
Compression
Compression serves to prevent further swelling as a result of the inflammatory process, and also by reducing bleeding at the site of tissue damage. A standard elasticated bandage the type of which are commonly available from most pharmacies, should be used to provide a comfortable compression force without causing pain or constricting blood vessels to the point of occlusion. It can also go some way to providing some basic protection of the injured body part from excessive movement, although this is not the primary purpose of the bandage.
Elevation
Elevation will prevent swelling by increasing venous blood return to bodily circulation and reducing hydrostatic pressure, thereby reducing oedema and facilitating waste removal from the site of injury. If your injury is in a lower limb, ensure that it is kept above the level of the pelvis when resting for maximum benefit – resting it on a stool or on several cushions if sitting on the couch, for example.
Following these basic procedures in the days following an injury will allow you the best opportunity of a speedy recovery. As with anything related to your body however, you should always consult a physiotherapist if you have any significant concerns over an injury, or if your pain/swelling doesn’t start to reduce within a couple of days. The guidance outlined here is for basic treatment only, and shouldn’t take the place of qualified medical advice when dealing with more serious injuries.
Gary Nisbet
B.Sc.(Hons), CSCS, NSCA-CPT, Dip. FTST
SquashSkills Fitness & Performance Director
Want to learn more about dealing with injuries?
Check out this series where Gary Nisbet talks through stages and expectations you might face after a serious injury and uses Peter Nicol as a case study to give his own experiences.
Learn more