Acute Injury Immediate Management


Compression should be applied to an injury as soon as possible to minimise the space available for swelling to become established. Furthermore, the potential for swelling is ongoing and dependent on the size of the area injured. Consequently, a big joint or large anatomical surface area can potentially swell for 72 – 90 hours following injury, whereas the swelling time for a small area will be significantly shorter. Therefore, it is important that compression is not removed too early.

The compression applied must also have something to absorb the outward tissue pressure such as cotton wool or a towel wrapped around the area and held in place with a crepe bandage. Unfortunately, the application of an elasticated bandage directly to the surface of the skin will not have the same benefits and it also tends to have a tourniquet effect as the injured part endeavours to swell. This then becomes extremely painful and frequently results in it being removed. Hence the reason for using something that will absorb the outward pressure of the potential swelling, whilst retaining the anatomical shape.

Wherever possible the compression should be removed 2 - 3 times per day and the injured limb actively and gently moved 2 – 3 times, through its pain free range. The compression should then be reapplied. This type of compression can and should be retained overnight but removed and reapplied if it causes any numbness, tingling, loss of sensation or discolouration of the skin below it.


Wherever possible, an injured area should be elevated above heart level. If this is not feasible then the highest position of elevation possible should be obtained and maintained. Elevation will limit excessive swelling by reducing the outward pressure of the blood within the damaged area. It will also encourage drainage and combined with compression is extremely effective and beneficial for the prevention of swelling following acute trauma.


The direct application of ice to an injured part does not prevent or stop swelling! However, sustained cooling combined with compression (and elevation) has the effect of providing analgesia (pain relief) in that area and, as such is beneficial. Consequently, blood flow through the area is reduced and swelling minimised and/ or prevented.

The cooling can be applied through the application of cold and/or ice packs wrapped around the outside of the compression or even soaking it with cold water. The cooling must also be sustained, where possible, for the period that the compression is applied. These are the principles on which commercial products such as Game Ready and Cryocuff are produced and so successful. Both apply sustained compression and cooling but without the dramatic contrasts in circulatory (vascular) responses that the direct application of ice gives. However, if it is not possible or practical to apply cooling in this way the key components of compression and elevation will still have a significant effect. 

NB: The principles above apply to the immediate treatment of an acute injury. However, if there has been repetitive injury or the activities were not stopped following the initial incident, the above principles can still be applied as soon as feasible but will need to be modified in the first 24 hours.


Modified rest, in this instance, does not mean doing nothing at all. It means modifying activities to prevent further trauma or re-injury. This is important as re-injury would change the physiological responses and increase the risk of it becoming a chronic problem. Therefore, a sensible approach to reducing activities must be undertaken and the advice of gently moving the injured limb through its pain free range, as described previously, should be followed. For the remainder of the time the injured part should be elevated when and wherever possible.


It is important to protect the injured area to prevent further trauma or re-injury. Therefore, immediate removal from the activity where the injury occurred is advised. An acute injury is one that has been subjected to a specific “one off” incident whereas re-injury or repetitive trauma will have a different response and make it potentially a chronic problem from the start. Hence the need to protect the injured area from further injury or repetitive trauma.


Always remember do no HARM until you see a qualified medical professional;
No Heat | No Alcohol | No Running | No Massage

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The Society of Sports Therapists Public Advice

The above information has been taken from The Society of Sports Therapists Public Advice Section for your information

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