What does PRICE stand for?
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.
Why the change?
They argue that whilst rest is sometimes warranted, it should be of a limited timeframe. Short term rest may be used to protect the joint/tissue from further aggravation. However, longer periods of unloading have been shown to be detrimental in the recovery of soft tissues.
Progressive loading is more likely to restore movement, strength and assist with tissue restructuring and healing. Overloading can also have a negative effect on healing, thus finding “Optimal loading” is better placed to guide the loading management of an acute injury than rest.
What is “Optimal load”?
Optimal loading means gradual rehabilitation to promote tissue remodelling. The use of loading within the management of musculoskeletal disorders is important through all stages of the injury and it will vary based on the anatomical structure that is injured. Khan (2009) introduced the term “mechanotherapy” as “therapeutic exercise prescription specifically aimed at promoting the repair or remodelling of injured tissue”. The mechanotherapy used on each person needs to be individualised to ensure that the tissue is not stressed to aggressively, in order to reduce the risk of re-damaging.
How do I know I have the right balance of rest and load?
The difficult clinical challenge is finding the balance between loading and unloading during tissue healing as the dose needs to be individualised to each person.
Each injury will have a set of milestones that you will need to try and achieve in order to ensure you are returning to full function. At SPS, all of our physiotherapists are highly experienced and recognise the appropriate stages of tissue healing that each person should be at. Having the Physiotherapist give you an accurate diagnosis of you injury, will mean they can guide you through the “optimal loading’ phase and ensure you are doing the right rehabilitation and goals are being achieved.
Reference: 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
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