Acute injury management – do no HARM?

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!


One thought on “Acute injury management – do no HARM?

  1. Pingback: Top 10 tips on managing running injuries | RunningPhysio

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