Acute Injury Management for Athletes

Acute injury management for athletes seems simple but is often overlooked.

What happens immediately after injury can set up a good outcome and quick return. Unfortunately, doing the wrong things can prolong the process and lead to poor results.

This guide is to help athletes understand all the elements that go into managing an acute injury.

If you're serious about your sport then read on.

No one likes to be injured and out of action.

However, suffering an injury is very common across all sports at all levels.

Some Stats

In Premiership rugby. On average, there will be two injuries per team, in every game, over the season. With an average of 32 days lost per injury.

Similarly, in Premier League football, there were 132 hamstring injuries and 110 knee injuries last season alone.

So what should you do if you pick up an injury? What will give you the best chance of a quick recovery?

Other guides will recommend PRICE protocols, which is great. But when recovery time really matters, we need to go deeper than that.

Acute Injury Healing

Following injury, there is a process of healing. This can be technical and difficult to fully understand. Athletes don't really need to understand the process fully. They do need to appreciate the basics though.

Having a basic understanding of the healing process enables effective acute injury management for athletes.

Healing can be broken down into three stages; inflammation, proliferation and remodelling.

Inflammation occurs immediately and then for around the first 48hrs. Typically, swelling occurs and is normally when the injury is the most painful.

Proliferation comes in next and is when the injured tissue is rebuilt. The structure is laid down ready for the final stage.

The longest stage is remodelling. With the structure in place, the new tissue needs to take on the required properties. This often involves stressing the tissue in a progressive way to aid the process. This is why good rehab is so important.

The purpose of acute injury management is to optimise each of these phases. They need to happen and cannot be missed out. 

Inflammation, in particular, has been thought to be a bad thing. Many practitioners still recommend anti-inflammatory medication and other ways to reduce inflammation. 

This is a mistake. For optimal healing to occur, inflammation is required. By taking medication to prevent inflammation it could impact negatively on healing. We need inflammation to occur, just not excessively. 

This demonstrates why acute injury management is so important for athletes. 

So what are the different areas we should consider?

Ice & Compression

This is a controversial one. 

But how can ice and compression be controversial? After all, it has been common practice for years.

Recently there has been a move to question if it is actually beneficial or not. Work by Gary Reinl certainly disputes the established norms. Reinl in his book "Iced!" cites studies showing that ice and compression can compromise recovery and may be causing more harm than good. Reinl points to using movement as a better option. Utilising the bodies natural recovery mechanisms instead.

For example. Rather than compress a sprained ankle and hold all the fluid around the joint. You could use an active or passive movement. This then allows the lymphatic system to move the swelling away from the joint.

Advocates of established methodology point to studies that show that it can hasten the return to sport. Plus many years of clinical practice. So the debate continues.

Experience shows that many athletes like using ice and compression. It gives them a job to do. They feel like they are starting the recovery process. Doing all they can to help. 

While the area is being debated. It is still recommended that ice and compression are used to manage acute injuries. But this may change in the future.

Sleep

It may seem strange to mention sleep in an acute injury management guide. However, to optimise the healing process, sleep is important.

Poor sleep has been shown to promote excessive inflammation. Which may then lead to a slower recovery.

While the amount of sleep is important. So to is the quality of sleep an athlete gets each night. There are a number of strategies to help with sleep quality. This article does a great job of summarising them.

One of the most important sleep strategies for athletes is limiting screen use before bed.

People today are spending more and more time looking at smartphones.  Doing so before bed can have a major effect on sleep quality. 

With limited amounts of poor quality sleep, we are not optimising the healing process. In fact, we are prolonging the inflammatory phase and blunting the effects of the rehab and treatment we are doing.

So, prioritise sleep while injured (although athletes should be anyway). Do everything to get in a good routine and maximise the work you are doing.

Nutrition

For athletes, providing fuel for the body is always important. When healing from an injury, this fuel is used to build and repair.

A good guide to nutrition when injured can be found here.

Poor nutrition during the acute phase of injury can compromise recovery.

There are two main elements to consider around nutrition when injured. Firstly, the volume of calories consumed. While an athlete will need fewer calories compared to when in training. There is still an energy demand that supports healing. 

It is important to ensure that athletes are not under or over consuming when injured. Ideally, a qualified nutritionist would support the athlete at this time. 

This isn't always possible. Taking regular body weight and body compositions measurements will help. As will monitoring what food is consumed each day (i.e. myfitnesspal).

The type and quality of calories are the second important consideration for athletes. Not all calories are created equally.

Protein is very important when injured. Increasing consumption is advised as tissue repair requires protein. The quality of the protein consumed is also important. Try to get most protein from good quality natural sources. Using supplements only when required.

Carbohydrate consumption can likely be reduced. Mainly due to the reduced training load.

Micro-nutrients (vitamins and minerals) also need to be monitored. Insufficient amounts or imbalances can impact on healing.

Overall, nutrition is as important to athletes when injured as when fully fit. Maintaining good habits and not making drastic changes when injured is recommended.

Mindset

Finally, having the right mindset is crucial to a speedy recovery from injury. 

There is never a good time for an injury. There is always a big competition around the corner. Or important trials coming up.

How the injury is approached can make a big difference to the outcome.

The initial shock, anger and sadness following an acute injury should be moved past as quickly as possible. 

Every hour and every day counts. There is no time to waste.

The phrase "injury is an opportunity" is fantastic for putting things in perspective. 

At what point during the season is there time to work on weaknesses? or master new skills?

By adopting this mindset it turns a negative into a positive. Instead of wasting the time in self-pity. The time is used to come back better than ever.

Easier said than done. But no one expects perfection. There will always be highs and lows.

Being aware is often half the battle. Having people around you who are positive can help massively. As can making a plan so you can see your progress.

Conclusion

As you can see. Acute injury management for athletes is much more in-depth than it first appears. This article barely scratches the surface.

By getting the basics right and looking at the whole picture, the time injured can be minimised. Healing can be optimised and time can be used most effectively.

After all. It's not just about getting back to sport.

It's about getting back better than before and staying back.