Author: Lene van der Linde (Lené van der Linde)

It is not only the world of dietetics that is being challenged with “less carbs, more proteins”. There has recently been a paradigm shift with the management of injuries.
The RICE principle has been known for years, guiding injury management. Rest, Ice, Compress and Elevate the injured area has been the primary principle that everybody followed. Later on, a ‘P’ for Protect was added to the acronym to form PRICE. These principles were widely used and perhaps abused? Currently the once-size-fits-all approach which seems to be followed with these two principles are being criticized. The management of a repairing tissue should rather be adapted from one scenario to another. There is now being suggested that we take the following into account before jumping to RICE or PRICE: the time that has passed since the injury, the type of tissue that has been injured, as well as the extent of the injury. To use different approaches for different situations might make more sense.

A tendon is made to resist to load. Tendon injury is usually the result of overloading or repetitive straining (overuse injuries) of the tendon. If the load is too much, the tendon has a subsequent “over”-reaction and is not inflammatory but rather degenerative in nature. A tendon injury can progress through three stages and, if not dealt with, can ultimately lead to tendon rupture. The injured tendon reacts differently in each stage of injury where it tries to protect itself against the forces and leads to changes in the tendon. These tendon changes can be referred to as tendinopathies. The management of tendinopathies are therefore different for each stage, which highlights the importance of primarily determining the stage of a tendon injury with a physiotherapist, before taking action to managing it.

A muscle strain occurs when the fibres have been overloaded and damaged. The healing phase of the damaged fibres starts immediately after injury and should also be well managed for the tissues to heal properly in the optimal time period for quicker return to normal activities or sport.
The different phases of healing will now be explained and compared to the restoration process of a part of a house that collapsed. The family of the house needs to move back as soon as possible to return to their normal functioning and routine. However, the family wants to leave enough time for the restoration so that it can be done properly. We all know that, similarly to healing, construction needs to be managed well for it to be done neatly and the process to be completed on time. The healing phases happen in typical time periods, but depends on the extent of the injury. The phases can also overlap, as with construction where things are done in parallel. As the workers wait for one part to dry, they carry on with another area. These phases are important to note in order to know what needs to be managed when, for the best possible outcome in the most optimal time period after an injury such as a hamstring strain.