It seems medical folk love a good acronym! We’ve had 3 already in managing acute injury. First we had RICE, then PRICE and then POLICE. I wonder if they just think up the word then fit the advice into it!?

What’s next Mobilisation Avoid NSAIDs Load Optimally Vertically Elevate? I can see it now on the RW Forum’s….”acute injury? What you need is MANLOVE!”….

Sadly manlove isn’t a recognised acronym in acute pain. Yet….

HARM though is a recognised acronym and details the things to avoid in the first 72 hours following an injury;

  • Heat
  • Alcohol
  • Running (or Re-injury depending on what version you use, both mean avoid excessive exercise)
  • Massage

I’ve highlighted avoid there in case you all get the wrong end of the stick and run around drunk with heat packs strapped to you, trying to massage each other!

What they say makes sense and is a helpful addition to the recommendations of POLICE and suggestions on use of NSAIDs.

Heat is thought to increase blood flow by causing blood vessels to dilate. This could lead to increased bleeding and swelling.

Alcohol is also likely to increase bleeding and may delay healing. Also it’s hard to follow the advice in POLICE if you’re rat-arsed!

Running or Re-injury through excessive exercise is sensible too. Healing tissue isn’t strong enough to manage the impact in running and is likely to breakdown causing further injury. You might think this would be fairly obvious but I have known runners to continue to run with alsorts of issues, including fractures!

Massage is also thought to increase bleeding and swelling, so I would avoid massaging directly over the injured area. A Physio may choose to massage distal to the swelling (further down the limb) to help reduce swelling, they may also massage to help acute low back pain so there are some exceptions.

This guidance comes from the New Zealand Guidelines Group and is available to download in full here.

As ever with injury the message from RunningPhysio is clear – if in doubt, get it checked out!


  1. Massage above the site of the injury to help ensure that any waste can drain/clear effectively. You can also do work to address any root causes. Importantly, do see your Sports Therapist as soon as possible – there are treatments that can be used within the first 24 hours that can aid rehab.

  2. I’m searching for some input. In training for a marathon, I injured my ankle and had to take 3 weeks off. The marathon is in 4 week and I was able to have a regular training week with an 11 mile training run last weekend. Should I/could I run this marathon? It’s the last Sunday in March…. If u think yes, I would love ideas for how to ramp up my milage?? This will be my 2nd Marathon. I also have 5 1/2’s under my belt and 2yrs of running…

  3. I injured my toe at work, I pivoted on a metal platform in work boots and felt a weird tug on my big toe. There was no initial pain and went about my work. The next day I felt a little pain in the second joint but it did not hinder me.
    I felt pain the third day and work through the fifth day. I started to treat the injury then and have experienced swelling and bruising. I was wondering how long the swelling generally lasts.
    It is now the seventh day and it seems to be subsiding. I have movement in all toes but they are stiff.

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