Getting injured during a workout or game—whether it’s a pulled muscle, sprained a ligament, or twisted ankle—can catch you off guard. For many the instant discomfort is swiftly followed by frustration and uncertainty. We’re often instantly wondering how severe it might be and what is the best way to manage it. Do we try and keep moving or do we ease off or stop completely? Is this an annoying niggle that we can push through or do we need to take this more seriously? In this blog we’ll discuss how to recognise the need to consult a clinician for ‘red flag’ symptoms and how to effectively self manage the more common types of injuries in their early stages.
Flags for immediate consultation with a doctor
Before diving into the specifics of initial injury management, it’s important to first identify any red flags that may indicate the need for medical consultation. Below are red flags for acute injuries that require immediate medical attention. You can use these as a guideline when you’re examining yourself in the early stages of injury.
Bilateral Symptoms: Pain or other symptoms affecting both sides of your body can indicate a more serious underlying issue, such as a systemic problem or severe nerve damage.
Severe and Unremitting Pain: Pain that is extremely intense, doesn’t improve with over-the-counter pain medications, or disrupts your sleep (waking at night) can be a sign of a severe injury or underlying condition.
Non-Mechanical Pain Behaviour: Pain that remains constant and doesn’t align with typical movement or activity patterns may point to serious issues such as an infection.
Abnormal Skin Colour or Temperature: Skin that appears pale, bluish, or has an abnormal temperature around the injury site can be a sign of poor blood flow indicating serious injury.
Persistent Swelling: Rapid or severe swelling that doesn’t improve with standard treatments could signal a serious underlying problem, such as a deep vein thrombosis or compartment syndrome.
Fractures: Severe pain, visible deformity, inability to move the injured area or weight bear, or significant swelling may indicate a fracture.
Dislocations: If a joint appears out of place, causes severe pain, or cannot be moved, it may be dislocated.
Concussions: Symptoms like confusion, severe headache, dizziness, nausea, vomiting, or loss of consciousness after a head injury may indicate a concussion or more serious brain injury.
Saddle Anesthesia: Loss of sensation in the areas that would touch a saddle (inner thighs and buttocks) can be a sign of cauda equina syndrome, which requires urgent care.
Upper Motor Neuron Lesions: Unexpected weakness, altered or loss of sensation, stiff or jerky movements, or exaggerated reflexes may suggest upper motor neuron lesions, often associated with serious conditions involving nerves and the spinal cord.
Glove Anesthesia: Numbness that feels like it’s in a glove pattern on your hands might indicate nerve compression or other neurological issues that need further evaluation.
Referred Pain: Pain radiating from the chest (e.g., left shoulder pain) or back could indicate serious conditions like a heart attack or lung issues.
History of Recent Surgery: New or worsening symptoms after recent surgery might be related to complications.
Medical History: Pre-existing conditions such as osteoporosis or diabetes can complicate injury recovery, so it’s important to consult a doctor if you have these conditions.
Steroid Use: Long-term use of corticosteroids can weaken muscles and tendons, increasing the risk of ruptures and other complications. Seek medical advice if you’re using steroids and experience a new injury.
In each of the above scenarios you should consider seeking immediate professional support. The good news news is that the majority of these issues are not common – however it’s an important to have an awareness of these red flags so that we can recognise them early and seek essential medical support when it’s really needed.
Initial management of common injuries
Once we have ruled out the red flags, we can consider some general guidelines for managing common injuries. These guidelines do not necessarily prevent the need for professional help but they are sensible, well established first steps and allow us a little time to evaluate whether or not we need expert guidance.
RICER (General guidelines for soft tissue injury):
- Rest: Avoid further activity to prevent aggravating the injury.
- Ice: Apply ice to reduce swelling and pain. Apply for 15-20 minutes every 1-2 hours during the first 48 hours.
- Compression: Use an elastic bandage to minimise swelling.
- Elevation: Keep the injured area elevated above heart level.
- Referral: Seek medical advice if symptoms persist or are severe.
POLICE (General guidelines for soft tissue injury):
- Protection: Use a brace or support to safeguard the injured area.
- Optimal Loading: Gradually introduce controlled activity to support recovery.
- Ice: Apply ice as described in RICER to manage swelling and pain.
- Compression: Similar to RICER, use an elastic bandage for swelling.
- Elevation: Keep the injured area elevated to reduce fluid buildup.
Additional Initial Treatment Principles:
- Rest and Protection:
- Symptoms: Pain and swelling that worsen with activity. Rest and protection help prevent further damage and support healing.
- Method: Follow RICER and POLICE
- Ice Therapy:
- Symptoms: Swelling, heat, or bruising in the injured area. Ice helps reduce inflammation and numb pain.
- Method: Apply ice for 15-20 minutes every 1-2 hours during the initial 48 hours.
- Compression and Elevation:
- Symptoms: Swelling and tenderness. Compression and elevation reduce swelling and support recovery.
- Method: Use an elastic bandage for compression and keep the injured area elevated above heart level.
- Pain Management:
- Symptoms: Persistent pain that disrupts daily activities. Pain relievers can help manage discomfort.
- Method: Use over-the-counter pain relievers like ibuprofen for very short-term pain control.
- Gradual Mobilisation:
- Symptoms: Stiffness and reduced range of motion as swelling decreases. Gentle movement prevents stiffness and maintains joint function.
- Method: Start with controlled range-of-motion exercises once acute pain and swelling subside.
- Consultation with a Professional:
- Symptoms: Persistent or worsening symptoms, or severe signs like inability to move the injured part. Seek professional evaluation for a comprehensive assessment and tailored treatment.
- Method: Consult a physiotherapist or doctor for a detailed examination and rehabilitation plan.
Sadly there are no magic tricks to curing injuries. However these guidelines can help you initially manage an acute sports injury before seeking expert advice if you feel it’s needed. If severe or unusual symptoms arise, prompt medical advice is essential so don’t delay in red flag scenarios.
As always, prevention is infinitely better than a cure so focus on an effective prehab routine to prep you for your lifestyle and sport of choice; monitor and adjust your training load using well established sports science principles; and keep an eye on your wellness markers so that you’re able to take a holistic approach to your training – life is much better injury free.
If you need help with science based injury prevention or treatment then download the Optimi app on Apple or Google.
References
1. Bertelsen, M. L., & Madsen, J. (2021). *Pain management strategies in acute injury treatment: A meta-analysis.* *Journal of Clinical Sports Medicine, 35*(1), 45-56. https://doi.org/10.1016/j.jcsm.2020.08.007
2. Hollis, S., & McCulloch, P. (2017). *The importance of professional consultation in sports injury management.* *Sports Medicine and Health Science, 1*(1), 12-21. https://doi.org/10.1016/j.smhs.2017.05.002
3. Hubbard, T. J., & Denegar, C. R. (2014). *The effectiveness of RICER in treating acute musculoskeletal injuries: A systematic review.* *International Journal of Sports Physical Therapy, 9*(2), 276-284. https://doi.org/10.1007/s00267-013-0160-4
4. Micheli, L. J., & Klein, M. (2017). *The role of RICER and POLICE in acute injury management.* *Journal of Sports Medicine, 51*(4), 290-298. https://doi.org/10.1136/bmj.j2950
5. Rochcongar, P., & Boutron, I. (2019). *Optimal loading and gradual mobilization in injury recovery: A review.* *Clinical Rehabilitation, 33*(2), 95-104. https://doi.org/10.1177/0269215518791854
6. Warden, S. J., & Keogh, J. W. (2020). *Compression and elevation in acute injury management: Evidence and application.* *Sports Health, 12*(6), 523-531. https://doi.org/10.1177/1941738120966734
