Previous Injury - POLICE 🚨
Injury can happen to anyone no matter your age, gender or athletic ability. However, there are some factors to consider that may make you more susceptible to certain injuries whether that be sports related injuries or non-sports related. One factor that may affect your injury risk is having a history of a previous injury.
Most minor to moderate musculoskeletal injuries can be treated in the acute phase by using the acronym POLICE:
P – protect – avoid the injury becoming worse
OL – optimal loading – finding what activities you are able to do and which ones you should avoid until the injury has had more time to heal. Some form of loading is essential to encourage healing of the area.
I – ice – apply ice to the area to help with pain management
C – compression – compress the area to minimise swelling and provide some support
E – elevation - elevate the injury to minimise swelling.
Lots of people are able to manage their injury well in this acute phase as a lot of it is common sense and things we have learnt from a young age. However, after a few weeks of rest and time for the injury to heal the pain gets better and people tend to go straight back to the level of activity they were doing before, without any rehabilitation. This is where it all goes wrong and is the reason why the reoccurrence rate of certain injuries is high.
Following an injury and a period of time being less active, even if this is only for a few weeks, that area will become weaker and the proprioception in the joints close to the injury will not be as good, (Proprioception is having an awareness of where your body is in space and it is closely linked to your balance and coordination).
Ultimately, after every injury the load tolerance around that area will be reduced so you have to spend time rehabilitating it to increase its load tolerance to the level it was at prior to the injury. In most circumstances, a good indicator for this is to see what the non-injured side is able to do.
For example, if you twist your left ankle when playing football, you may not be able to walk properly for a week. This will almost definitely affect the strength and proprioception around your ankle. Before you go back to playing football the strength and proprioception in your left ankle should be at least the same as the right. Specifically for an injury to the ankle you should be comparing single leg heel raises, single leg banded dorsiflexion and eversion and single leg wobble board challenges to compare the load tolerance of the injured side to the uninjured side.
Another way that previous injury increases the risk of getting a further injury is related to our psychology. When we are carrying an injury or feel we have a weakness we will unconsciously (and sometime consciously) change the way we move to favour the non-injured side. For example, if we injure our left leg, we may try to compensate by using our right leg more which could result in overloading the right leg and therefore injury. If we injure our left arm, we will try to do things with our right arm instead which could lead to over loading the right arm and therefore injury. Take a look at these sports' specific examples;
If you have your first game of rugby back from a left shoulder injury you will try to avoid tackling with your left shoulder and use your right more often. Favouring one side will often result in poor technique which could lead to right sided shoulder injuries, concussions, and neck injuries like stingers.
If you have your first game of netball back from a left ankle injury you will try to avoid jumping and landing on this side from fear of pain or re-injury. Instead, you will change the way you play so that you mostly jump and land on your right ankle. This increases the risk of overloading the right ankle which could result in injury.
To stop this cycle from happening you need to feel confident that the initial injury has healed and it is strong and stable enough to meet the demands you want to place on it during training or in a game. This is where end stage rehabilitation and return to play techniques are used, as they provide a controlled environment to practice what you will be doing before you go in to an uncontrolled game environment. If you miss this important stage of rehabilitation out, you put yourself at an increased risk of injury re-occurrence and injury to other body parts.
TOP TIPS TO TAKE HOME
In the acute stage of an injury (first 48 hours) apply the POLICE principle.
Thorough rehabilitation is crucial no matter where the injury has occurred or the degree of injury.
Before you go back to your chosen activity, make sure your injured side is, at a minimum as strong as your non injured side. Use single leg strength and balance testing to achieve this.
Seek advice from a qualified healthcare professional that specialises in injury management and rehabilitation, such as a physiotherapist.