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The acronym PRICE (Protection, Rest, Ice, Compression, Elevation) has long been central to the acute management of soft-tissue injuries despite any significant high-quality evidence to support the different components or collaborative approach.
Recent literatures have advocated the use of loading in the management of musculoskeletal disorders. Bleakley et al (2012) have discussed changing PRICE to POLICE, or more specifically changing the rest component with optimal loading. They argue that whilst rest is sometimes warranted, it should be of a limited timeframe. Longer periods of unloading have been shown to be detrimental in recovery of soft tissues and progressive loading is more likely to restore the strength and morphology characteristics of collagenous tissue. It is also known that too much loading may be detrimental to tissue healing, thus optimal loading is better placed to guide the loading management of an acute injury than rest.
The use of loading within the management of musculoskeletal disorders is important through all stages of injury. Khan (2009) introduced the term “mechanotherapy” as “therapeutic exercise prescription specifically aimed at promoting the repair or remodelling of injured tissue”. The paper goes on to present several high quality research papers demonstrating the use of loading within the management of various musculoskeletal disorders.
The difficult clinical challenge is finding the balance between loading and unloading during tissue healing. At SPS, all of our physiotherapists are highly experienced and recognise the importance of using movement in the process of tissue healing.
Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE. Br J Sports Med 2012; 46: 220
Khan KM, Scott A. Mechanotherapy: How physical therapists’ prescription of exercise promote tissue repair. Br J Sports Med 2009; 43: 247-251