A three-part series on proactive intervention by BIOKINETIX
In Part I, we addressed why it’s important to help injured employees recover without interrupting the healing process.
The traditional return-to-work approach has often failed American workers, and the problem of recurrent injuries is just one example. After analyzing workers’ compensation data over a 3-year period, Liberty Mutual researchers found that a disproportionate amount of low back injuries were recurrent. Compared to those who had only been injured once, employees with recurrent injuries took longer to recover, accumulated significantly higher medical and indemnity costs, and were considered by study authors to be “an especially important target for secondary prevention efforts” [4]. Recurrent injuries can be prevented entirely by making sure employees recover properly the first time—so why are they still so common?
Bridging the gap between public health research and practice has always been a challenge. Although functional rehabilitation has long been utilized by sports medicine practitioners, many occupational programs and policies still overemphasize passive rehabilitation. One example of this inconsistency is RICE: a popular acronym that advocates rest, ice, compression, and elevation as treatment for soft-tissue injuries. Coined by Dr. Gabe Mirkin in his 1978 bestseller, “The Sports Medicine Book,” RICE became a model for responding to strains and sprains that is still relatively popular today. Walk through any industrial facility and you’ll be sure to find at least one reference to RICE among many workplace safety posters.
Beyond inflammation
The problem with RICE is that it perpetuates outdated information. Contemporary medical literature clearly advocates optimal loading as a best practice for soft tissue injury recovery. RICE, on the other hand, is representative of a once-favorable approach in which movement was restricted to reduce swelling. This reflects a common misconception—although inflammation may be uncomfortable and inconvenient, it’s a sign that the immune system is working to heal the injured tissue. In fact, many physicians do not prescribe anti-inflammatory medication within the first 48 hours of an injury as to avoid interrupting the healing process. This process begins with inflammation and continues with repair, regeneration, and remodeling of the damaged tissue.
RICE is just meant to minimize bleeding in the inflammation phase, or no longer than the first six days after an injury. After the initial pain has subsided to a manageable level, the injured person should begin engaging in gradual, controlled movements as to enable the muscle to heal [1]. Avoiding movement longer than necessary may reduce short-term discomfort, but stops the damaged muscle from healing correctly. Disuse creates muscle tension and joint stress as the surrounding tissues are forced to work harder to compensate for the weakened area. In this state of imbalance, the body develops poor patterns of movement in response to stress, increasing the risk of recurrent injury and chronic pain. This is what is known as the injury cycle: a pattern of poor rehabilitative strategies that ultimately drive up recurrent injury rates in the workplace.
Breaking the injury cycle
While RICE may be an appropriate first-aid response, experts agree it’s no substitute for functional rehabilitation. In 2014, Mirkin himself publicly acknowledged that his previous findings have been contradicted, citing evidence that “both ice and complete rest may delay healing instead of helping” [2]. Although Mirkin may have recanted his support for RICE, he left a lasting cultural impression. Is it too late to fix our collective understanding? Perhaps another memorable acronym is the answer. Forget RICE—the medical community has started to embrace POLICE, which replaces the no-longer-relevant components with a modern emphasis on early movement [3].
- Protection of the injured area from further damage by monitoring external symptoms and avoiding extreme loading.
- Optimal Loading is engaging in early, controlled movement by limiting (and gradually increasing) the workload as physiological capacity is restored.
- Ice should be applied no longer than 15-20 minutes at a time within the first 48 hours of an injury.
- Compression bandages can help minimize swelling and stop hemorrhage.
- Elevation of the injured area above the heart can help increase blood circulation.
The POLICE method is a great example of what proactive intervention looks like in practice. With the help of on-site medical professionals, following POLICE can help employees break out of the injury cycle and avoid chronic pain or recurrent injuries. For employers, it’s a way to prevent medical-only claims from progressing into costly disability, as well as minimizing productivity loss: several studies have demonstrated that return-to-work interventions reduce the number of days away from work for employees with acute back pain [5]. While the injury cycle often results in persistent pain, choosing proactive intervention strategies can help employees rebuild strength and restore function in the long term.
References
- Järvinen, T. A., Järvinen, M., & Kalimo, H. (2013). Regeneration of injured skeletal muscle after the injury. Muscles, Ligaments and Tendons Journal, 3(4), 337–345.
- Mirkin, G. (2015). Why Ice Delays Recovery. DrMirkin.com. Retrieved from http://www.drmirkin.com/fitness/why-ice-delays-recovery.html
- Bleakley, C.M., Glasgow, P., & MacAuley, D.C. (2012). PRICE needs updating, should we call the POLICE? British Journal of Sports Medicine, 46, 220-221. http://dx.doi.org/10.1136/bjsports-2011-090297
- Wasiak, R., Kim, J., & Pransky, G. (2006). Work Disability and Costs Caused by Recurrence of Low Back Pain: Longer and More Costly Than in First Episodes. Spine, 31(2), 219-225. http://dx.doi.org/10.1097/01.brs.0000194774.85971.df
- Hlobil, H., Staal, J., Spoelstra, M., Ariëns, G., Smid, T., & van Mechelen, W. (2005). Effectiveness of a return-to-work intervention for subacute low-back pain. Scandinavian Journal Of Work, Environment & Health, 31(4), 249-257. http://dx.doi.org/10.5271/sjweh.880
