The Ultimate 5 Step Recovery Guide: Step 1 - PRICE
When it comes to injuries, there are a million and one theories on the best way to approach recovery. Should you rest? Ice? Deep tissue massage? Seek medical attention? Like a good scientist, our answer is "it depends." It depends on your injury, your level of fitness, symptoms, personal history, and more.
But, that doesn't mean we can't develop a template —a Decision Support System —that you can use to self-diagnose and self-rehab.
In this article, we lay out the fundamental steps for recovering from any minor injury. The goal is to arm you with enough knowledge so that you know when to seek medical attention, when to rest, and when (and how) to push through your injury to the other side.
You did it again. And it wasn’t from something crazy — like down-hill running or trying to do a backflip off your house. You were just doing what millions of people do every day. Lifting weights, running, playing tennis, or kicking a soccer ball. And now your knee is busted. Or your shoulder is clicking and throbbing. Or your elbow is so sore you can hardly pick up a dumbbell (or computer mouse). The worst thing you can do is pretend it’s not happening. Try to tough it out. That’s a recipe for ending up on the operating table. Or at least having to take a 6-8 week hiatus from working out. The inconvenient truth is that minor injuries happen all the time.
You’ll be hard-pressed to find any high-level athlete that hasn’t battled through multiple injuries. The people who stay healthy and continue making progress over the long haul have figured out how to quickly recognize and address these minor setbacks. There’s a fine line between pushing past discomfort and risking serious injury. But with some training experience, and being brutally honest with yourself — you can be your own rehab specialist. While your injury — and your physiology — is much too individual to address with an exact recipe, we can still provide the framework for navigating through minor strains, “tweaks”, and other overuse injuries like tendinopathy.
That being said… We know you're tough — but you also need to be smart.
If you suspect a serious injury or if you have any of these signs, get some help. This article is NOT a replacement for medical attention:
When to seek medical attention:
- Abnormal bone, joint, or muscle positioning (e.g. it looks crooked or is misshapen)
- Excessive swelling, bruising, bleeding
- Sharp pain when performing previously pain-free movements
- Inability to bear weight on the limb or joint without it giving way
- A feeling of abnormal “looseness” in the joint
A torn hamstring is treated in a completely different way than tendinopathy in the knee, or a sprained ankle, or herniated disc in the back. There’s just too much variability to provide an exact recovery protocol you can follow no matter the injury. So instead, the goal of this article is to
- give you a baseline understanding of the rehab process
- help you determine when it’s OK to self-diagnose and when you should seek medical attention
- show you how to establish recovery goals and timelines
- and most important — how to prevent it from happening again
Use this guide as a template for bouncing back from your next sprain, strain or case of tendinopathy.
Let’s get into it.
STEP 1: Stop and PRICE.
Stop doing everything.
Even if you don’t know what caused your injury, stop. Because you might be missing something crucial that could make it worse.
Example — Let’s say you’re doing jump squats while holding dumbbells. And you feel a tweak in your knee. Not a pop or a tearing feeling. Just a tweak. Like something isn’t quite right. What do you do? If you’re like most people, you stop doing the jump squats. And you kick yourself for not warming up better. Or starting with lighter weight. Or you just kick yourself for doing an exercise that has a high potential for injury. Then, you head on over to the leg extension machine or the squat rack and finish your workout. Seems like a reasonable plan of action, right? Probably not. Here’s why.
In this scenario, it most likely was NOT the exercise that got you injured. After all, a properly warmed up human being should be able to squat down with resistance and stand up fast. Even explosively. Without injury. So it wasn’t the exercise that got you injured necessarily. It was knee joint positioning and imbalances in the musculature around your knee cap. So moving on to another exercise might not make sense. Because you could have an underlying imbalance or structural issue that needs to be addressed. The smart thing to do would be to go home, research your symptoms, and figure out what’s going on. (Or consult a professional). Now, you can’t leave the gym every time you feel an ache or pain. You’d never get anything done. But you have to be smart. Listen to your body. And know the difference between soreness, general discomfort, and problematic “tweaks” or pains. The more training experience you have, the more you can trust your intuition about whether training through pain is a good idea. But that takes time.
My point is this: what you absolutely CANNOT do is injure yourself slightly… tweak a muscle or joint.. then keep going and turn that tweak into a full-blown tear.
The second component of step one is PRICE. PRICE stands for Protection, Rest, Ice, Compression, Elevation. If you’ve heard this acronym before, don’t skip this part. While it remains the go-to treatment for most physical therapists, athletic trainers, and rehab specialists — it’s not clear that it actually helps.
In fact, in some instances — P.R.I.C.E. can slow your recovery.
Let’s look at the four components of PRICE, and figure out when it makes sense to apply this old school technique:
PRICE component #1 - Protection
Not too long ago, the "P" in PRICE was added to RICE (Rest, Ice, Compression, Elevation). The P stands for Protection. Which is too important to assume it goes without saying. In this instance, protection means prevent further injury. This may include limiting the use of a weight-bearing leg that's injured or immobilizing an injured wrist until you can get a better idea of what is going on. Protecting the lines of stress is an important concept to remember. that is, injured tissues are more fragile than non-injured tissues. The bottom line is simple: do whatever you have to in order to prevent any more damage. A partially torn tendon, ligament, or muscle is susceptible to a more serious injury that will prolong the recovery process.
PRICE component #2 - Rest
This means exactly what you’d think. Stop using the injured area. And don’t do any activity that irritates it. But — you have to apply some common sense here. A torn rotator cuff deserves complete rest. While tendinitis in the elbow requires a different kind (and time range) of rest. I can’t tell you how long to rest. Or what type of rest to use. Without first knowing the severity and type of injury. For serious injuries, you clearly will be resting for quite a while. Until the injury resolves itself, or you get the necessary medical help. But for more minor sprains or strains, movement is your best friend.
In fact, some clever writer came up with the term M.I.C.E. — Movement, Ice, Compression, Elevation — to illustrate the importance of continuing to move after injuries. This isn’t a bad idea. But there is always a rest component — even if it only lasts a day or two. Let’s come back to this idea of “rest.” Because before knowing how long and what type of rest to employ, we have to diagnose the type and level of injury.
PRICE component #3 - Ice
Use ice, cold packs, or cold water therapy to minimize swelling and prevent excessive inflammation. The general recommendation is to apply ice for 10 to 20 minutes, three times per day for the first 48 hours. Ice therapy makes intuitive sense. So most people don’t question its validity. Ice reduces swelling and numbs the pain. Must be good right? Plus, there is plenty of anecdotal evidence to go around. (I was religious about icing my arm after every baseball game I pitched as a kid. It seemed to help.)
But studies show that icing might actually hinder the healthy inflammation response that ensues after an injury. This can lead to abnormal collagen formation and reduced muscle fiber volume. In one animal study, injured rats who were NOT treated with ice therapy had 65% greater cross-sectional muscle mass than the group that was treated with ice. Human studies parallel these findings. In most circumstances, ice therapy does more harm than good. Here’s why ice delays recovery and hinders athletic performance:
Healing Requires Inflammation
The acute inflammatory response (immediately following an injury) dilates capillaries and blood vessels, increasing the delivery of oxygen and nutrient-rich blood to the injury site. Inflammation also helps mobilize macrophages, a type of cell that speeds up healing and prevents infection by cleaning up damaged tissue. And, macrophages release a hormone called IGF-1 into the damaged tissues, which kick starts the healing process. By reducing inflammation too much immediately following an injury, you're interfering with a complex healing process.
Ice therapy reduces strength speed and athletic performance
This is true both in the short run and in the long run. A meta-analysis of 36 articles demonstrated that ice therapy was not effective for helping athletes recover from a non-serious injury and get back in the game (picture a baseball player icing his arm between innings, then trying to go back out and play a few minutes later). This practice reduces muscular power and endurance. And, we already know that in the long run ice therapy can lead to abnormal tissue regeneration and reduced muscle mass in the injured area.
This begs the question, when is it appropriate to use ice therapy?
According to Dr. Gabe Mirkin, the guy who coined the term “RICE” in 1978, the answer is sparingly. If at all. And really only to control pain. That’s right, the doctor who founded this whole protocol has updated his opinion. And good for him. Based on new research, he determined that ice does more harm than good and publicly stated that he doesn’t support it anymore. But even though there is plenty of research to refute ice therapy as a treatment for muscular injuries and enhanced recovery (like sprained ankles) — we still use it.
So do some of the world's top coaches, trainers, and athletes.
Thing is, studies are great. We clearly love them around here. But they’re limited. They don’t take into account the multitude of circumstantial variables you deal with when treating a minor injury or trying to improve recovery time. So, though I respect the literature on the subject, I’m more interested in what I have seen work in the real world. And in my experience, ice therapy has certainly helped speed up recovery time and get myself (and people I’ve worked with) back to training. Partially due to the fact that it reduces DOMS (Delayed Onset Muscle Soreness). In the case of sprained ankles, I’ve seen time and time again that icing immediately following the injury helps reduce swelling and get the athlete back to full range of motion (ROM) sooner. Some studies back this up. For example, ankle pain and swelling in the absence of structural damage leads to subsequent muscle weakness and range of motion loss, which could increase the chance of re-injury.
So even if I’m blocking a few macrophages by icing, that’s OK. Because whatever cellular level effects I’ve interrupted have been trumped by the fact that I can start the important rehab work necessary to regain strength and flexibility. The same goes for nutrients that reduce inflammation. If they improve injury recovery outcomes, reduce excess swelling, and prevent systemic inflammation — they're smart tools to use post-injury. Bottom line. When it comes to injuries, getting back to pain-free ranges of motion ASAP is crucial.
So I support any tools that help accomplish that goal (granted you aren't overusing painkillers and ice while simultaneously destroying tissue that clearly needs rest).
A study on non-steroidal anti-inflammatories (NSAIDs) demonstrated that trainees over the age of 65 who took anti-inflammatories during a 12-week exercise program had greater increases in muscle size than those that took a placebo. Think about that for a minute… NSAIDs interfere with the inflammatory healing process. So wouldn’t you expect the control group who took NSAIDs to have reduced recovery times, smaller muscles, and weakened athletic performance? Well, that’s not what happened. Why? Because the tool, in this case, NSAIDs, allowed them to complete the training program. It helped them get back into the gym. It’s tricky though. So you still have to make this decision on a case-by-case basis.
The verdict: Like any tool, ice therapy should be used only when it makes sense. If you’re in doubt, don’t use ice. Assuming you have a minor injury, tweak, or sore muscles — let your body do its own work without interfering.
But, if ice therapy or cold baths help you bounce back and continue training, then by all means use it. But only apply ice for 20 minutes at a time, and try to limit icing to the first 24 hours. Personally, I try NOT to use ice for acute injuries or chronic tendinopathy.
PRICE component #4 - Compression
This typically involves wrapping the injured area with cotton or elastic bandages. This is another sticky subject. Because not only does it need to be applied ONLY in certain circumstances, but doing it the wrong way can cause serious harm. Wrapping an extremity too tightly can cause nerve damage. Or at least, exacerbate swelling. Using a compression technique that is too loose causes a false sense of security, and can lead to further injury. Timing is important too. Studies show that immobilizing a joint immediately following an injury can help accelerate the formation of granulation tissue at the site of the injury. But the duration of reduced activity (immobilization) should be limited ONLY to the time necessary to facilitate enough healing to continue normal movements. For a muscle tear, this means that you want just enough scar tissue to form so that you can move the joint without rupturing the newly formed tissue. Basically, as soon as possible — you want to start moving. If you tear a muscle or tendon, you have a long road ahead of you. And compression therapy can be helpful for the first week in order to facilitate the initial tissue rebuild. You’d have to work with your doctor or physical therapist to determine when and how to start moving again. For more minor strains, compression can be an effective tool when used appropriately. Compression wraps or sleeves limit mobility immediately following a minor injury to prevent further damage. And in some cases, it helps the athlete complete other training modalities. But this should only be used immediately following the injury.
The most common mistake is becoming dependent on compression to move around. The use of knee braces comes to mind. All too often, I see people tweak their knee and start using compression sleeves or braces to support their knees. Pretty soon, they have to wear their extra-thick knee braces just to do an upper body workout. Or move boxes around in the garage. (Knee injuries, in particular, seem to benefit from leaning more toward mobility than immobility following an injury). That’s because the musculature around the knee has atrophied. And they’ve lost the necessary strength to stabilize the joint through full ranges of motion. If you tweak your knee and need some extra support in order to complete a workout, just remember that you have to work twice as hard to build up and maintain the strength and mobility in your knees necessary to support them without the brace. And just like ice therapy, compression tools are a good idea when they help you keep moving when you would otherwise be laid up on the couch.
For example, elbow sleeves and knee sleeves help tack down muscle and joint tissues into their most biomechanically advantageous positions. This helps you move through a full ROM (Range of Motion) pain-free and trains your body to use proper form — even if you’re battling tendinopathy or a recent elbow tweak. The people who stay healthy and continue making progress over the long haul have figured out how to quickly recognize and address these minor setbacks. The key is not to become dependent on compression. Feel free to use compression wraps or sleeves immediately following a minor injury so you can continue moving around and getting things done. But remember that if you’re feeling sharp pain or the joint just doesn’t feel right, you could have a serious injury that needs to be addressed. Don’t use any tool to keep moving when you know you should get off your feet and see the doctor. And, remember that if you use compression therapy that you’ll have to work twice as hard to maintain joint strength and mobility.
The verdict: Use compression therapy when you need it to continue moving. If you use braces, wraps, or sleeves — dedicate time each day to performing low risk, pain-free movements without the compression device. Doing this at the end of each workout is a good routine to follow. I recommend this for anyone who has to use knee compression wear in order to perform knee-heavy movements (e.g. barbell squat).
PRICE component #5 - Elevation
Exactly what you think. This means raising the injured area above the level of your heart to help drain fluid from the injury. Picture yourself sitting on the couch with a swollen, sprained ankle. And placing that ankle on a high footstool in front of you to relieve the throbbing.
We don’t need to over-complicate this one. For serious injuries, elevation helps control bleeding and swelling. For minor injuries, it helps reduce pain and swelling. Much like ice therapy and compression, elevation is most effective during the first few hours following an injury. Beyond that, there isn’t much benefit to it.
Stay tuned for Step 2 of The Ultimate 5-Step Recovery Guide.
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