From the Guidelines
The initial management of soft tissue injuries should prioritize rest, limiting the use of the injured extremity, and cold application to decrease pain and swelling. According to the 2024 American Heart Association and American Red Cross guidelines for first aid 1, the mainstay of treatment for strains and sprains is rest and limiting the use of the injured extremity. This approach avoids worsening the injury, especially when there is uncertainty about whether an injury is a sprain, strain, or a fracture.
Some key considerations for managing soft tissue injuries include:
- Limiting the use of the injured extremity to prevent further injury
- Applying cold therapy to decrease pain and swelling, with the greatest tissue cooling achieved by using a bag filled with ice and water surrounded by a damp cloth
- Limiting the duration of cold application to 20 to 30 minutes for 3 to 4 times daily to prevent cold injury
- Avoiding direct placement of ice on the skin to prevent cold injury
It is essential to note that while cold application can decrease pain and swelling, it has not been demonstrated to improve function or time to recovery 1. Therefore, the focus should be on providing symptomatic relief and supporting the healing process through rest and limited activity. By following these guidelines, individuals with soft tissue injuries can receive appropriate initial management and reduce the risk of further injury or complications.
From the Research
Initial Management Steps for Soft Tissue Injuries
The initial management of soft tissue injuries involves several key steps to promote healing, reduce pain, and prevent further injury. These steps can be summarized as follows:
- Rest: Avoid activities that aggravate the injury 2, 3, 4, 5
- Ice: Apply ice to the affected area to reduce pain and inflammation 2, 3, 4, 5
- Compression: Use compression bandages or wraps to reduce swelling 2, 3, 4, 5
- Elevation: Elevate the affected limb above the level of the heart to reduce swelling 2, 3, 4, 5
Pain Management
Pain management is an important aspect of soft tissue injury treatment. The use of oral paracetamol and/or ibuprofen has been studied, with no significant difference found in pain score between the two 6. Non-steroidal anti-inflammatory drugs (NSAIDs) may also be used to relieve pain and swelling, but their use should be limited to the first few days after injury 2, 4.
Rehabilitation
Rehabilitation is a crucial step in the recovery process, with early mobilization and progressive resistance exercises essential for restoring full muscle and joint function 2, 3, 4. The goal of rehabilitation is to restore the injured and adjacent tissues to full pain-free functional capacity under competitive conditions, in association with the necessary level of cardiovascular respiratory fitness 2.
Treatment Principles
The treatment principles for soft tissue injuries have evolved over time, with the RICE (rest, ice, compression, and elevation) method being widely accepted 2, 3, 5. More recent principles, such as POLICE (protection, optimal loading, ice, compression, and elevation) and PEACE&LOVE (protection, elevation, active movement, compression, elevation, pain, and load management), have also been proposed 4.