It has become apparent that physio’s all have a different management strategy when dealing with acute pitch side injury. This was highlighted recently at a conference I went on where an audit of physio’s use of ice varied from 10 mins to 45 mins in the acute stage. I feel that we need to have a standardised approach to pitch side acute management that will have the best impact on reducing the severity of the injury and promoting a quick return to football. The academy medical team has proposed the following guidelines that we would like all part time physio’s to use whilst working with The Football Academy.
Remember, current research suggests that compression is probably the most important aspect of acute injury management. This should be combined with Rest, Elevation and Ice.
- Ice should only be used for 10-15 mins every 1 to 1 ½ hours as icing for longer can lead to tissues necrosis. Advise players and parents about regular icing at home until reviewed by weekday physio and about preventing ice burns. Use ice either in the form of an ice bag or as foot/ ankle baths. A foot bath provides hydrostatic pressure to help drain inflammatory exudate. In the initial 24-48 hours post injury players may also be advised to set an alarm clock every 2 hours through the night to ice for 10 mins. Although this will disrupt sleep and tissue repair the benefits of preventing further bleeding and minimising inflammatory exudate are paramount during this period.
- Advise about having the injured area elevated as much as possible to drain inflammatory exudate.
- Use medirip (brown elastic bandage) with foam for compression as opposed to taping as the player can take off and reapply the medirip, which aids bathing and icing. Compression can be used overnight if it is comfortable and the player feels there is no excessive sensation of compression or numbness.
- Administer elbow crutches if there is pain with weight bearing even if only for 24 hours as this will limit bleeding and scar tissue formation. Ensure the player knows to return this to the physios at the training ground.
- Reinforce that the player MUST rest until assessed by weekday physio. This includes PE at school.
- Where a player is diagnosed with a muscle strain, they should be withdrawn from a match situation. Playing with any acute muscle strain, be it a Grade 1 or a fascial strain, will lead to considerably more damage and a much worse prognosis. As explained last year and backed up by a Finnish study published in AJSM, acute muscle strains should not be stretched.
Remember, current research suggests that compression is probably the most important aspect of acute injury management. This should be combined with Rest, Elevation and Ice.