What Is the P.O.L.I.C.E. Principle?

The P.O.L.I.C.E. principle may be the new way to ice and otherwise treat a musculoskeletal injury, such as a sprain or strain. The acronym stands for the five steps involved: protection, optimal loading, ice, compression, and elevation.

One thing it's missing? Rest, a component of the long-used R.I.C.E. method (rest, ice, compression, and elevation). Some healthcare practitioners now consider P.O.L.I.C.E. an advanced and favored approach.

This article describes how each approach differs and why the P.O.L.I.C.E. method may be the better option if you're faced with an acute injury.

Why R.I.C.E. Was Recommended

Under the R.I.C.E. method, for an injury such as a sprained ankle, your healthcare provider would tell you to rest your leg and apply ice to the ankle while elevating your leg and using some form of compression (like an elastic bandage).

The thought process is that in the initial days following injury, your body brings a lot of blood and fluid to the injured site. While this aids with healing, it also causes swelling and pain while reducing the range of motion (ROM) of the joint.

Ice helps by reducing pain and inflammation. Elevation and compression, in turn, help reduce swelling and the build-up of fluid around the injury.

The Problem With R.I.C.E.

While the R.I.C.E. technique makes sense, it has a few shortcomings. According to some researchers, it hasn't really been proven to work as well as many people think it does.

One study published in the Journal of Athletic Training found a lack of solid evidence that the R.I.C.E. treatment for ankle sprains leads to better outcomes. In fact, some experts believe that applying ice right after an injury impedes the normal healing process.

Another problem with the R.I.C.E. technique is that many people take the "rest" phase too far when they would benefit from gentle exercises and movement.

Resting too long can lead to a loss of muscle strength and flexibility and end up delaying healing.

Why P.O.L.I.C.E. May Be Better

Today, some healthcare providers are recommending the P.O.L.I.C.E. method instead of R.I.C.E. The P.O.L.I.C.E. method is broken down as follows:

• Protection
• Optimum loading
• Ice application
• Compression
• Elevation

Protection

During the first few days after an injury, you should certainly rest the injured joint, ligament, tendon, or muscle. But, after that, you should start gentle motions while maintaining the protection of the injured area.

For leg injuries, for example, you may require some sort of assistive device, like crutches, to walk.

Optimum Loading

This describes the gentle motion you can start while in the protection phase.

For example, after a shoulder injury, you should be able to progress from a few days of rest to passive ROM movements, active ROM movements, and, finally, rotator cuff strengthening exercises.

Ice Application

Ice can help to reduce the swelling around an injured muscle or joint while decreasing some of the acute pain you may be feeling.

Your healthcare provider can help demonstrate the best ways to apply ice to an injury. They can also teach you how to make your own ice pack.

Compression

In addition to ice application, you can add compression to the injured joint or muscle with an elastic bandage.

You can also use a product like Ice Tape to cool and compress the injury at the same time.

Elevation

An injured ankle or knee can be elevated by placing it on a stack of pillows.

An injury to your elbow or wrist requires you to elevate your entire arm.

How Physical Therapy Can Help

The P.O.L.I.C.E. principle is a simple method to try on your own, although you may benefit from injury-specific instructions from an orthopedist or physical therapist (PT). This is especially true if an injured joint or limb needs extra protection.

For example, a shoulder injury may require the use of a sling, while a knee ligament injury may require a brace during the initial healing phases.

Your PT can advise you on exactly how much protection your injury requires as well as when it's time to start using the limb again.

A PT can also guide you in the optimal loading phase by offering a progressive day-by-day or week-by-week roster of exercises you need to perform.

With the optimal rehabilitation plan, you should be able to return to normal activity without having to worry about stiffness or the loss of strength that can occur following a prolonged period of rest.

Summary

The P.O.L.I.C.E. method of treating an acute injury deviates slightly from the traditional R.I.C.E. method of rest, ice application, compression, and elevation.

For the P.O.L.I.C.E. method, "rest" is replaced by injury "protection" and "optimal loading" with movement. This helps keep your injured limb mobile while decreasing stiffness and speeding recovery.