Emergency Treatment for Acute Injuries: The P.O.L.I.C.E. Principle

Still Using R.I.C.E. after an Injury? Try the P.O.L.I.C.E. Principle Instead

Proper treatment of acute injuries may include the P.O.L.I.C.E. principle.
The P.O.L.I.C.E. principle may be best for acute injuries like sprains and strains. Getty Images

The P.O.L.I.C.E. Principle may be the new way your physical therapist approaches your acute injury treatment.

For many years, physical therapists, as well as athletic trainers, doctors, and sports medicine specialists have recommended the R.I.C.E. principle to manage acute injuries.  The acronym stands for Rest, Ice, Compression, and Elevation.

If you have suffered an injury, like a sprained ankle, your healthcare practitioner would likely recommend treating it initially using the R.I.C.E.

acronym.  First rest the injured area.  Then apply some ice to your injury using some form of compression (like an ACE bandage), and elevate the injured body part.

The thought process behind this is that in the initial days following injury, your body brings a lot of blood and fluid to the injured site to prepare it for healing.  But your body brings too much fluid to the injured area.  This excessive fluid limits range of motion (ROM) around your joint, and can actually delay proper healing.

While the R.I.C.E. technique makes sense, there are a couple problems with it.  First, it hasn't really been proven to work like we think it works.  One study published in the Journal of Athletic Training found that there is a lack of solid evidence that the R.I.C.E. treatment for ankle sprains leads to better outcomes after the injury.  Some experts believe that ice applied initially after an injury impedes the normal healing process.

Another problem with the R.I.C.E. technique is that many people take the "rest" phase a little too far.  Often after acute injury, a little bit of rest is necessary.  But you may feel compelled to rest your injured muscle or joint for far longer than is actually necessary.  A long period of immobilization can lead to decreased muscle strength and flexibility.

  This may actually delay your return to normal functional mobility and activity.

So is there another action to take after a sudden injury like a ligament sprain or muscle strain?  Some physical therapists are recommending the P.O.L.I.C.E. principle.  The P.O.L.I.C.E. acronym is as follows:

  • Protection:  During the first few days after an injury, you should certainly rest the injured joint, ligament, or muscle.  After a few days, gentle motion can be started while you still maintain a level of protection for the injured area.  During this time you may require some sort of assistive device, like crutches, to walk.
  • Optimum Loading:  While you are protecting your injured body part, gentle motion can, and should, be started.  For example, after a shoulder injury or shoulder surgery, you should be able to progress from a few days of rest to passive ROM, active ROM, and finally, rotator cuff strengthening exercises.  This progressive loading of your injury can help promote optimal healing of the injury, and it can prevent delays in returning to normal due to joint and muscle tightness or muscle atrophy.
  • Ice: Applying ice may help to manage the swelling around your injured muscle or joint, and ice can help decrease some of the acute pain that you may be experiencing.  Your PT can help you determine the best method of applying an ice to your injury.  He or she can also teach you how to make your own ice pack.
  • Compression:  While applying ice, compression can be added using an ACE bandage.  You can also use a product like Ice Tape to cool and compress the injury.
  • Elevation:  Elevation is simple for some body parts.  An injured ankle or knee can be placed on a stack of pillows while you are lying down.  An injury to your elbow or wrist requires that you elevate your entire arm on something.  Your PT can help advise you of the best way to elevate your injury.

The POLICE principle is a simple method to try after acute injury, but a visit to your physical therapist may be necessary.  He or she can first help you figure out the best protection for your injury.  For example, a shoulder injury may require the use of a sling initially, and a knee ligament injury may require a brace during the initial healing phases.

Your physical therapist can advise you on exactly how much protection your injured body needs, and he or she can tell you when it is time to stop protecting the injury and start using the injured body part.

Your physical therapist can also guide you in the "optimal loading" part of the P.O.L.I.C.E. principle.  After injury, you may be required to perform simple exercises and motions to allow your injured muscle or ligament to heal properly.  As your injury heals, your physical therapist can change your exercises to ensure that optimal loading and proper healing occurs.

If you have suffered an acute musculoskeletal injury like a sprain or muscle strain, a visit to your doctor or physical therapist is a good first step in your care.  He or she may recommend the P.O.L.I.C.E. method to treat your injury.  The P.O.L.I.C.E. method is a simple acronym to help ensure that you protect your joint, optimally load your joint, and get the benefits of ice, compression, and elevation.  Following this method may help you return to your normal activity quickly and safely.

Source:  van den Bekerom, M., Struijs, P., etal. (2012) What Is the Evidence for Rest, Ice, Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults?. Journal of Athletic Training: Jul/Aug 2012, Vol. 47, No. 4, pp. 435-443.
Bleakley, C.,Glasgow, P.  (2011) "PRICE needs updating, should we call the POLICE?" Br J Sports Med doi:10.1136/bjsports-2011-090297.

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