MICE Principle For Soft Tissue Injuries

Introduction of MICE Principle:

• It is a simple self-care technique that helps to cure your soft tissue injuries.
• It has the following benefits :
• Help to Reduce swelling that occurred because of injury.
• Will also help in the reduction in the amount of pain caused by injured tissues.
• Will speed up your duration of recovery.
• And also will help to make the healing process of damaged soft tissue as early as possible.

What do you mean by soft tissue injuries?

• In our body anatomical structures like Ligaments, muscles, capsules, fascia, Or bursa all are considered soft tissues.
• Due to some specific mechanism, these anatomical structures may get injured.
• So the structures are impaired by the injury and they limit their routine or normal function.

What is the full form of MICE?
OR
MICE stands for:

• M stands for Mobilization or movement
• I stands for Ice
• C stands for Compression
• E stands for Elevation

The MICE principle is described in detail as follow :

Mobilization or Movement:

• Movement can produce mechanical forces sufficient to produce stretch and disrupt the healing process.
• It is the way to achieve early but safe mobilization is only done by protected mobilization.
• Application of movement will prevent stiffness ,will help to maintain muscle strength and improve nourishment of articular cartilage.
• Mobilization should be used at optimal levels with appropriate grade , range, force, direction , speed and duration to achieve specific treatment aim.
• It is required for each stage of the healing procedure.
• For an example :
• Application of Transverse friction :
• It will prevent or reverse the connective tissue changes occurs due to previous period of immobilization.
• After an injury the non–injured structures are allowed to move.
• For an example :
• In MCL strain cases the knee brace will prevent valgus strain.
• But the non-injured structures are allowed to move safely.
• So the application of mobilization with some protection is always better from complete immobilization.
• Early mobilization in patients with acute limb injuries like :
• Ankle sprain
• Stable fracture cases
• Surgical tendon repair
• Will decrease the amount of pain and swelling
• Will increase the functional activities.
• It will give more benefits in comparison with cast immobilization.

Ice:

• It is also known as ‘ Cryotherapy ‘
• Application of cold will reduce pain by making the affected area numb.
• What type of physiological effects can be seen after the application of cold?
• Cold reduces Tissue metabolism.
• So by this phenomenon there will be constriction of the blood vessels.
• The application of ice will also decrease the nociceptive propagation of stimulus to the brain.
• Which will reduce pain sensations.
• Will also helps to reduce muscle spasm occurred because of soft tissue injury.
• You can apply ice with the help of the following:
• Ice packs
• Ice bags
• Before application of ice packs or ice bags, wrap it in a cloth or towel whatever is available.
• It will help to prevent frost bite.so before application make sure it does not touch the skin directly.
• In emergency situations, you can also use ice bags of frozen vegetables.
• What is the procedure of the application of ice?
• Apply ice over the injured area for approximately 10 to 15 minutes.
• Or for 4 to 8 times in a while day.
• It will definitely help if you will apply it within first 3 to 4 days of injury.
• Always remember that never allow the ice packs or bags to directly touch the skin.
• What will happen if you apply ice for a prolonged duration?
• It may reduce or decrease excessive blood flow into the applied area.
• It will cause skin burns because the nerves present under the area will get damaged.
• In which conditions you can not apply ice therapy?
• Or Contraindications of ice therapy :
• Patient diagnosed with Raynaud’s syndrome.
• Diabetic patients
• Patients having urticaria from the cold application.
• Paroxysmal cold hemoglobinuria
• Circulatory insufficiency already present.
• Hypersensitivity from cold.

Compression:

• It is given with the help of elastic bandages, by wrapping the bandage around the injured area.
• Elastic bandages should provide comfortable compression force without causing pain and constriction of blood vessels.
• It should not be too loose or too tight.
• It is important to wrap it from distal to the affected area and then move in a proximal direction.
• Method of application :
• The figure of the eight methods.
• If you find that skin below the wrapped area changes its color like blue or you feel cold , numb or tingling kind of sensations in your affected extremity so you need to loose your bandage immediately.
• If symptoms does not get normal, then take medical help.
• Because when it will be too tight , it will interrupt with your normal blood flow.

What are the benefits of compression?

• It will keep the swelling or edema under control by the pressure of elastic bandages.
• It will also help to provide support to the affected extremity or area.
• It will help to reduce the loss of blood flow from the damaged tissue.
• Will also reduce the further accumulation of the swelling or edema in surrounding structures as well as the affected areas.
• Procedure:
• After injury giving compression for at least one week will be more effective to reduce the amount of swelling.
• Wrap your bandage tight enough only to support your injured area.
• Apply it from distal to proximal direction.
• Apply it like that it should stop the blood flow from injured blood vessels.

Elevation:

• Here you need to elevate your injured area.
• Keeping the affected area elevated, will reduce the amount of swelling or edema for sure.
• For upper limb injuries , you need to elevate your affected extremity above the level of your heart.
• For lower limb injuries , you need to elevate your affected extremity above the level of pelvis.

What are the Physiological effects of elevation?

• It will prevent further swelling by increasing the venous return.
• It will also help to reduce hydro-static pressure.
• It will increase the amount of removal of waste materials from the site of injury.
• Will also help to reduce pain and discomfort associated with soft tissue injuries.
• What are the uses of elevation?

• By elevation of the injured area, it will make the difficulty for blood to reach up to that area.
• So there will be a reduction in loss of blood flow.
• After the injury, it is best to elevate the area for 2 to 3 hours a day.

What to avoid during treatment of Soft tissue injuries?
For the period of the First 48 to 72 hours you need to avoid HARM :

• HARM stands for :
• H : Heat
• A : Alcohol
• R : Running or activity
• M : Massage

Heat :
You need to avoid the application of heat to the injured area.
Because it will increase the blood flow and swelling in that area.
It will lead to blood loss.
So it will delay your healing process.

Alcohol:

Consumption of alcohol will increase blood flow into your body by stimulating receptors.
It can also make you unaware of your injury.
So there are chances of recurrence of an injuries.

Running or Activities:

You need to stop doing activities in the affected region.
So protect your injured structures until healing occurs.

Massage:

Massage will promote an increase in the level of circulatory blood flow.
If given in early stage it can also increase the damage of soft tissue.

Here are some examples of soft tissue injuries in which you can use MICE Principle as a treatment method.

• Muscular strains :
• It Occurs from mild trauma or repeated trauma.
• The most common mechanisms are over-stretching of muscles or overuse of soft tissue is found to get muscular strains.
• It is classified according to the type of trauma.
• What kind of activities causes Muscular strains?
• By doing activities that involve repeated movements
• Or by lifting heavy objects in a wrong manner might cause muscles to get rupture.
• This kind of activity can cause muscular strains.
• RICE treatment method is a widely and frequently recommend method for various soft tissue injuries.
• It can give better results when you begin the treatment immediately after injury and continue it for the next 24 to 48 hours.

Ligament sprains:

• It happens Because of severe stretch or tearing or rupture of soft tissue.
• It is also classified according to the severity of the traumatic injury.
• What kind of activities causes Ligament sprains?
• It occurs by the activities like :
• Tripping of the joint
• Falling from the height
• Sudden Twisting activities
• So because of this kind of activities you will get or suffer from your ligament Sprains.

Dislocation:

• Displacement of the bony part in the joint results in a soft tissue injury.
• Because of this there will be loss of anatomical relationship.

Subluxation:

• Incomplete or partial dislocation of a bone in a joint is called a subluxation.
• Secondary trauma will occur here to the surrounding soft tissues.

Muscles or Tendons rupture or tear :

• There are 2 conditions :
• If partial tear or rupture occurs :
• Pain will be felt during resisted activity.
• If a complete or full tear or rupture occurs :
• The movement will not occur.
• Muscle fibers are not able to pull against resistance.

Pathologies of Tendons :

• Tenosynovitis :
• Inflammation of synovial membrane which is the covering or the tendon.
• Tendinitis :
• Inflammation of a tendon.
• Tenovaganitis :
• Inflammation with thickening of a tendon sheath.
• Tendinosis :
• Degeneration of tendon due to repetitive micro trauma.
• It occurs because of the aging process.

Synovitis :

• Inflammation of synovial membrane caused by trauma or any kind of disease.

Hemarthrosis :

• Bleeding into a joint because of severe trauma.

Ganglion :

• Ballooning of wall of the joint capsule or tendon sheath.
• It occurs due to trauma or sometimes can be seen in patients with rheumatoid arthritis.

Bursitis :

• Inflammation of a bursa.

Contusion :

• Bruising from a direct blow will result in a rupture, bleeding, and edema in the affected area.

Contractures :

• Adaptive shortening of skin, fascia, muscle, or joint capsule.

Adhesions :

• Abnormal adherence of collagen fibers to surrounding structures.
• It occurs most commonly during the phase of immobilization after traumatic injuries or surgery.

Muscle guarding:

• Prolonged contraction of a muscle in response to the painful stimulus.

Muscular spasm:

• Prolonged contraction of the muscle in response to the local circulatory and metabolic changes occurs when a muscle is in a state of contraction.
• Muscular spasms may also be seen in the following conditions :
• Viral infection
• Cold
• A prolonged period of immobilization
• Direct trauma to muscles.

What kind of symptoms are seen after soft tissue injuries?

• Pain
• Swelling or edema was noted in the surrounding area.
• Visible bruising can be seen
• Limited movement of the affected joint.
• Muscular weakness noted.
• Muscle spasm is seen in relevant areas.
• Joint instability is seen in severe injuries.