Injuries to muscles, tendons, ligaments, and nerves are often referred to as ‘acute injuries’ and will happen to most people throughout their lives.

In the early stages of a soft tissue injury (the first 48-72 hours), the body’s protective system sends an immediate response to the injured area which often manifests as inflammation, pain, or swelling. The key focus of acute injury management is to reduce pain and minimise the inflammatory response.

So, how do we manage acute injuries?

Unload or restrict movement for 1–3 days to minimise bleeding, prevent distension of injured fibres, and reduce the risk of aggravating the injury. Rest should be minimised as prolonged rest can compromise tissue strength and quality. Pain signals should guide the cessation of protection.

The various phases of inflammation help repair damaged soft tissues. Thus, inhibiting inflammation using medications may negatively affect long-term tissue healing,

The use of ice/cooling is questioned*. Despite widespread use among clinicians. Even if mostly pain-relieving, ice could potentially disrupt inflammation, new blood vessel formation, delay healing cell infiltration, and increase immature muscle fibres. This may lead to impaired tissue repair and redundant collagen synthesis.

In real-world practice that ice does have its place. Take for example an acute ankle sprain some can still not weight-bear on an injured ankle. Weight-bearing as able is a load that is known to improve initial outcomes. Therefore, the pain-reducing effect of icing can help to get the ankle weight-bearing, improving function and long-term outcomes.

External mechanical pressure using taping or bandages helps limit joint swelling and tissue bleeding

Education on the many benefits of an active approach to recovery is key

Mechanical stress should be added early with normal activities resumed as soon as symptoms allow. Optimal loading without exacerbating pain promotes repair, remodeling and builds tissue tolerance and the capacity of tendons, muscles, and ligaments.

Optimistic patient expectations result in better outcomes and prognosis

Pain-free aerobic exercise should be started a few days after injury

Exercises help to restore mobility, strength, and balance control early after injury