PRICE vs POLICE
PRICE
RICE acronym was introduced by Gabe Mirkin in 1978. From this acronym, different variations came into the healthcare field that includes RICER, PRICE, PRICER etc...
Protection
Protect the injured area by partial or full immobilization with brace or splinting or taping.
Rest
Concept of rest is to reduce metabolic demands of injured area and thus avoid increased blood flow.
Ice
Application of ice reduces injury induced damage caused by local increase in temperature. it produces vasoconstriction of injured capillaries and reduces bleeding. icing produces analgesic effect by increasing latency period of free nerve endings.
Compression
The goal of compression is to stop the hemorrhage and reduce swelling. it reduces inflammatory exudates from swelling. also helps to control osmotic pressure of the injured area.
Elevation
Elevation of injured part above the cardiac level helps draining the exudates through lymphatics. thus, elevation reduces swelling.
POLICE
POLICE acronym is an updated version of traditional PRICE protocol.
P.R.I.C.E → P.OL.I.C.E
- Protection
- Optimal Loading
- Ice
- Compression
- Elevation
What is Optimal Loading
Optimal loading may be defined as the load applied to structures that maximises physiological adaptation. Achieving optimal loading is challenging but should be driven by variables such as the tissue type, pathological presentation and the required tissue adaptation for eventual activity. Specific loading goals may include increased tensile strength, collagen reorganisation, increased muscle–tendon unit stiffness or neural reorganisation.
In other words, optimal loading is about effect of mechanical loading on the tissues (mechanotherapy). Mechanotransduction refers to the process by which the body converts mechanical loading into cellular responses. These cellular responses, in turn, promote structural change. A classic example of mechanotransduction in action is bone adapting to load. A small, relatively weak bone can become larger and stronger in response to the appropriate load through the process of mechanotransduction.
Loading methods
Following are some methods that can be used as starting loading of the injured tissues.
- Isometrics → Eccentrics → Isotonics
- Aquatic therapy
- NMES / Russian currents
- Gait training with crutches.
(NWB → PWB → FWB)
Why Complete Rest is bad for healing?
First of all, Rest is not bad in immediate acute stage of injury. but, it is substandard management of injury healing compared to early loading or mobilization. Instead of improve the tissue healing, there will be the process of deconditioning due to rest.
- Philip Glasgow, Nicola Phillips, Christopher Bleakley., Optimal loading: key variables and mechanisms (2017).
- K M Khan, A Scott., Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair(2009).
- Chris M Bleakley, Seán O'Connor, Mark A Tully.,The PRICE study (Protection Rest Ice Compression Elevation (2007).
- C M Bleakley, P Glasgow , D C MacAuley., PRICE needs updating, should we call the POLICE? (2012).
- Wikipedia.,RICE (medicine).
- Ethne L. Nussbaum et al., NMES For Treatment of Muscle impairment (2017).
- Matthew Buckthorpe et al., Benefits and use of aquatic therapy during rehabilitation after acl reconstruction (2019).
| Name | : | Deva senathipathi |
| Qualifications | : | Physiotherapist |
