HARM PRICEM

In "Healing By Primary Intention", TriExpert asked me to elaborate on the no HARM concept. To do so I need to include the other aspects about soft tissue injury management as well.


Let's accept that the first 24-72 hours following a soft tissue injury (such as a muscle tear, tendon strain or ligament sprain) is the acute phase. The basic concept of treatment is based on two principles:
  1. Don't do anything to cause further injury or impair recovery.
  2. Do what you can to enhance recovery.

With just a little bit of knowledge the rest is common sense. Something I believe about all of first aid.

Point 1 is covered by the no HARM concept. In reality it is just a mnemonic to help remember things. I was first introduced to it in about 1998 while studying Human Movement as part of the class Care and Prevention of Athletic Injuries.

Point 2 is covered by PRICEM. Which is the RICE principle that most people are familiar with, with two extra points.

no HARM: avoid these things as they are likely to cause further injury or impair recovery. In fact if you do these then anything you hope to gain by trying to enhance recovery using PRICEM is likely to be completely negated.

H=Heat

Increases the metabolic rate above safe cellular levels and impairs the recovery processes.


A = Alcohol

Is a vasodilator and increases swelling beyond appropriate levels at and around the injury site. May also impair certain aspects of the inflammation process.


R = Running (exercise)

Likely to cause further mechanical trauma to injury site. Disrupts initial and important actions in removing and isolating injured cells.

M = Massage

As for R, causes mechanical trauma and disrupts initial important actions on injured cells. Massage does play an important role once past the acute phase.


The two extra points on PRICEM are


P = Prevention

Can be interpreted as employing methods to prevent injury in the first place such as appropriate conditioning, use of correct footwear and everything else that gets covered ad nauseum.

In the case where an injury has already occurred, then it is simply about preventing further injury. These include methods of stopping the activity that causes the injury, removing yourself from any dangers (such as get off the cycling course if you've fallen at the bend).

R = Rest

Kick back, relax, sleep and let the parasympathetic activity take over. Rest and digest versus fight and flight.

I = Ice

Icing the injured area has a number of benefits. One in particular is it reduces pain. Of most importance icing lowers the temperature at a cellular level and therefore decreases the metabolic rate. This slows down the rate of secondary injury caused by the toxic substances released from damaged cells, plus creates a more suitable environment for an appropriate inflammatory response.

Lowering the temperature is very effective and is used in more extreme cases of injury such as protecting the brain following cardiac arrest, and is currently being investigated for severe traumatic brain injury.

In icing an injury the recommendation is apply covered ice for 15-20 minutes every two hours during the acute phase. This allows a slowing of metabolic rate without lowering the cellular temperature too low. Too low a temperature will cause further cellular damage, even cellular death. This is often the case when ice is applied in a method like 10-20min on then only a rest break of 10-20min as used to be recommended.

C = Compression

Keeps the swelling under control through mechanical restriction. Sometimes the body goes overboard unless gently guided.

E = Elevation

Allows drainage from the injury site which helps control swelling, but more importantly facilitates removal of waste products from the injury site.

M = Medical diagnosis/treatment

Have the injury properly assessed and apply the correct rehabilitation once past the acute phase. Recovery and repair works best when guided towards being functional. Left as purely a passive process the injury site is likely to be filled with inflexible scar tissue, which while strong doesn't have any of the functional characteristics of muscle, tendons or ligaments.

Comments

  1. and so we learn every day...
    great post! cheers!

    ReplyDelete
  2. thanks for all this. Very timely for me. Just 'pulled' my calf muscle AGAIN!

    ReplyDelete

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