Though inflammation is required for proper healing of injuries, an excessive or prolonged inflammatory response can become self-perpetuating and destructive.  Therefore, controlling or suppressing inflammation is one of the primary goals of overuse injury treatment. 

     Control of inflammation has received considerable attention in the medical literature.  The classic approach is R.I.C.E., an acronym for rest, ice compression, and elevation.  Now, in many clinics, physical therapy centers and athletic training rooms you see the words prevention/protection, modalities, and medications added to the acronym to create P.R.I.C.E.M.M.  Nearly all protocols for managing overuse injuries begin with the athlete abstaining from, or modifying, exposure to abusive activity.  Rest, however, does not mean halting all activity.  Over the past three decades, medical researchers have gradually realized the possible benefits of exercising when injured.  The advice of total rest after an injury may be outdated and counter productive.  Painful conditions arising from inflammation actually improve when patients keep moving.  Relative rest protects the injured area while avoiding the consequences of de-conditioning and disuse atrophy.  To prevent re-injury and ensure better compliance with rehabilitation programs it is best to emphasize what recuperating athletes can do to enhance healing and maintain fitness rather than what they cannot do.  Athletes with lower extremity injuries, for example, can frequently duplicate land workouts in a swimming pool.

     Modalities and medications are fundamental to controlling inflammation and are frequently incorporated in the treatment of overuse injuries.  Their role, however, has yet to be clearly defined.  Discuss all of these options with your physician or athletic trainer.  It may be best to use both approaches to assist in pain control so an athlete/patient can make a quick transition from relative rest to rehabilitative exercise.

     If you believe you have sustained an injury, have persistent pain and swelling in a joint with limited range of motion, see your doctor.  FAF is not attempting here to diagnose or treat any injury however minor, prescribe medications, rehabilitate or counsel patients in any area of health and fitness.  This site does not provide you with any medical advice.  This is general information that is not to be substituted for physician directed care.

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     Some health care professionals and centers like to use the R.I.C.E. acronym for the recovery process, meaning:

R:  Range of motion:  Healing tissues tend to scar which in turn tends to shorten muscles making them more susceptible to subsequent injury.  Regain range of motion through passive flexibility exercises which take the muscle to the fullest extensibility with tightness but without pain.  Hold 10-20 seconds.  Consciously relax the muscle being stretched.  No bouncing!

I:   Isometrics:  Healing often requires relative resting of the injured part and protecting it from further activity until swelling is dissipated and pain is gone.  Slight or significant detraining can occur according to the length of the layoff.  Strength can be gradually rebuilt starting with isometrics.  Create muscle tension during the isometric contraction, but stop short of pain.  Count slowly to eight and relax.  Repeat for three sets.

C:  Calisthenics:  The injured part should be put through the normal range of motion with light resistance created by one’s own body weight.  This action will gradually begin to build strength again.  Repeat the calisthenic movement for 8 to 12 repetitions.  Do not work through pain.  As strength improves, use weights heavy enough to provide resistance but light enough to avoid pain, move weights through the full range of motion very slowly.  Elastic resistance may be substituted for weights.  Repeat for 8 to 12 repetitions.  The muscle should feel somewhat tired on the last couple of repetitions.

E:  Exercise at 50%:  Return to exercise that caused the injury.  Use about half of the effort required before injury.  Concentrate on the motor skills necessary to produce the movements smoothly and efficiently.  Use a longer-than-normal warm-up and stretching period before the workout.  Return to normal activity keeping in mind that healing usually continues even after pain is gone.  Don’t return to previous levels too soon.  Exercise at 100% only after following each of the previous steps, slowly building flexibility and strength in the injured area.