Injury Management: First 48 Hours

Posted on by Ross Harris

Sports injuries are NOT inevitable but, sadly, they are common. All athletes should have a basic knowledge of first aid but, even more important, they should understand and follow the relatively simple guidelines for injury management when, and if they occur.

A small amount of early care can significantly reduce your recovery time. Appropriate treatment in the first 48 hours will limit the damage to the tissues and reduce the swelling, bleeding and pain that hinders your recovery. Ultimately, this will result in less time spent away from your sport.

A recent study by Bleakley, Glasgow and MacAuley 2012 in the British Journal of Sports Medicine has suggested that the PRICE Guidelines (Protect, Rest, Ice, Compression, Elevation) for dealing with acute injuries are now outdated, and have suggested using the acronym POLICE for the early management of injuries. This stands for:

  • P – Protect
  • OL – Optimal Loading
  • I – Ice
  • C – Compression
  • E – Elevation


Support the injured part using the likes of tape, strapping, crutches, casts or braces to help protect it against further damage. This is particularly useful if you are having problems weightbearing, in which case you will need to get a medical professional to assess your injury. Take care with self strapping as poorly applied tape can make your injury worse!

Optimal Loading

This is the major change in the protocol suggested by Bleakley et al. So why do they suggest replacing rest with optimal loading? While rest may be helpful in the short term, continued rest may lead to joint stiffness, muscle weakness and tightness and reduced proprioception (control and balance). Optimal loading will stimulate the healing process as bone, tendon, ligament and muscle all require some loading to stimulate healing. Also, the appropriate amount of activity can actually reduce swelling. For example, with an ankle injury, walking around will cause the calf muscles to contract, pumping the swelling up the leg against gravity. With complete rest the swelling may pool in the ankle.

Obviously there are some injuries that do require complete rest, such as unstable fractures or complete tendon ruptures, so optimal loading in these situations would be no loading at all. If there is excessive swelling or pain with your injury, or if you are in any doubt about weightbearing, contact a health professional and they will be able to assess your injury and advise you on how to proceed. As a rule of thumb you should begin weightbearing if you are able to walk without limping and the pain is tolerable.


The application of ice immediately after injury reduces the amount of pain, bleeding and swelling. Ice can be applied in a number of ways:

  • Crushed ice (or frozen peas) wrapped in a damp towel
  • Frozen gel packs
  • Instant ice packs
  • Immersion of part in ice and water

Never apply ice directly to the skin as this may cause a burn.

Placing a damp towel or cloth between the skin and the ice will help prevent this.

Ice should be applied as soon as possible after the injury. The ice pack should be applied for 20 minutes every 2 hours. Although rare, leaving the pack on for longer than 20 – 30 minutes may cause an ice burn. The skin should be checked under the ice pack after 2 or 3 minutes to make sure there are no signs of an ice burn (blistering).

Ice should not be applied in the following cases:

  • Raynaud’s disease
  • Poor tissue circulation
  • Poor tissue sensation


Compression of the injured area with a firm bandage will help reduce swelling around the injury. The bandage needs to be stretchable and should be applied firmly, but not so tightly as to cause pain, and should be applied both during and after ice application. Bandaging should be started just below the injury, with each layer of the bandage overlapping the underlying layer by half, and should extend to at least one hand’s breadth above the injury. Ensure there is good circulation distal to the bandage (i.e. in the toes if the ankle is compressed).


Elevation of the injured part is very effective in reducing swelling and pain. It can be achieved by using a sling for upper limb injuries and by resting lower limbs on a chair or pillows. It is important to ensure that the lower limb is above the level of the pelvis.

What to Avoid in the First 48 Hours:

  • Hot baths
  • Hot packs
  • Alcohol
  • Massage
  • Exercise (remember optimal loading!)

When to Apply Heat

Heat can promote healing by increasing blood flow to the injured area, however, in the first 48 hours this will increase swelling and slow your recovery. Heat treatments can be started once swelling has subsided, usually after 48 – 72 hours.

Early Injury Management: Summary

Minor sprains and strains can be treated using the POLICE protocol, however, if the symptoms persist for more than a few days, or the injury is more serious, you should contact a physiotherapist for further assessment and treatment.

Remember – the sooner you start treatment after injury, the sooner healing can begin, and the sooner you’ll be back playing sport.

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