POLICE Principle For Soft Tissue Injuries:

POLICE Principle: An Overview:

• The POLICE Principle is the modified principle of soft tissue injuries.
• it will help to improve your recovery from your injuries like sprain, strain.

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 POLICE?
or
What does POLICE stand for?

• P stands for Protection
• OL stands for Optimal Loading
• I stand for Ice
• C stands for Compression
• E stands for Elevation
• All these are described below in detail :

Protection :

• Protecting the injured area from further injury is a key to treatment.
• In this phase, the use of support is recommended.
• Ex: By using crutches to protect the lower limb from injuries.
• It is important to protect the injured area to avoid further tissue damage.
• For example :
• If you hurt your knee while playing cricket, so you need to stop playing cricket to protect your injured area.
• Protection also helps to give an appropriate amount of rest for the healing process.

Optimal loading :

• All the soft tissues like bone, tendon, ligaments, or muscles all require some loading to stimulate their healing process.
• With the help of the utilization of mechanotherapy and manual techniques, you can give loading to the tissue.
• In the early stage of rehabilitation or recovery use of supportive devices like crutches or braces may have a greater role in adjusting the optimal loading.
• The accurate amount of activities can also help to counter or manage edema.
• For example :
• Active movement of ankle joint:
• Through these movements, the calf muscle fibers will contract and will drain the accumulated fluid up to the body from against gravity.
• So some amount of movement is required for early healing.
• In some specific Conditions, optimal loading is mandatory
• Like in case of fracture.
• Here the optimal amount of load will give traction force to maintain the normal alignment of the fractured bone.

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.
• It will also help to reduce muscle spasms 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 them in a cloth or towel whatever is available.
• It will help to prevent frostbite. so before applying 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 for 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 the 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 prolonged durations?
• 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 :

• The patient was diagnosed with Raynaud’s syndrome.
• Diabetic patients
• Patients having urticaria from the cold application.
• Paroxysmal cold hemoglobinuria
• Circulatory insufficiency is 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 the 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 lose your bandage immediately.
• If symptoms do not get normal, then take medical help.
• Because when it will be too tight, it will interrupt 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 the 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.

Here are some examples of soft tissue injuries, where you can use this principle as a treatment tool.

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 lifting heavy objects in the wrong manner might cause muscles to get rupture.
• This kind of activity can cause muscular strains.
• 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 in the activities like :
• Tripping the joint
• Falling from the height
• Sudden Twisting activities
• So because of this kind of activity, you will get or suffer from ligament Sprains.

Dislocation :

• Displacement of a bony part in the joint results in a soft tissue injury.
• Because of this, there will be a loss of an 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 the 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 the tendon sheath.
• Tendinosis :
• Degeneration of tendon due to repetitive microtrauma.
• 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 the muscle in response to the painful stimulus.

Muscular spasm :

• Prolonged contraction of a muscle in response to the local circulatory and metabolic changes occurs when the 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 the relevant area.
• Joint instability is seen in severe injuries.

What to avoid during the treatment of Soft tissue injuries?
For the period of the First 48 to 72 hours, you need to avoid HARM: It is described below in detail.

• 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 injury.
• 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 an early stage it can also increase the damage to soft tissue.