Many acute sports or exercise injuries can safely be managed at home for a few days, until symptoms are relieved or until a physician can perform an in-office evaluation.

Existing medical research does not definitively support any specific treatment regimen, but most medical professionals and textbooks agree that the initial home treatment for mild and moderate injuries should be guided by the R.I.C.E. or P.R.I.C.E. protocol—Protection, Rest, Ice, Compression and Elevation. These principles have been a mainstay of acute sports and exercise injury management for decades.

In This Article:

When to go to the ER

Acute sports or exercise injuries generally occur as a result of a specific event, such as falling on an outstretched hand, collision with another athlete, landing awkwardly, or quick acceleration. An athlete may sustain a sprain or strain, contusion or fracture, dislocation or partial dislocation (subluxation).

While many injuries can be immediately treated at home, suspected fractures and dislocations warrant emergency medical evaluation. In the event of deformity, inability to bear weight, or worsening signs and symptoms, emergency medical evaluation is recommended. A trip to the ER is also advised if the injured person becomes notably pale, loses pulse, or experiences paralysis, tingling, or extreme pain, as these can be signs of damage to blood vessels or nerves.


Basic Science of Acute Injury

An acute injury results in damage to soft tissues, including skin, fascia, cartilage, muscle, tendon, and/or ligament tissue. Damage to bones or nerves can also accompany these injuries.


This damage can be accompanied by:

  • localized pain
  • swelling
  • redness or bruising
  • limited range of motion
  • decreased function

How and why do these symptoms appear? A cascade of events occurs following a traumatic injury:

  • The twisting, tearing, or blunt force trauma leads to the microscopic damage of small blood vessels and connective tissues.
  • This microscopic damage results in blood, plasma, and cellular fluid leaking into nearby tissues.
  • The leaking of fluid, along with the collection of chemical mediators and dilation of blood vessels, cause acute injury swelling.
  • As the blood migrates towards the skin’s surface, the skin may appear dark red or have the characteristic “black and blue” appearance of bruising.
  • The sensation of pain is a result of the fluid collection, certain chemicals released in the body (as a result of cellular injury), and lowered oxygen levels in the soft tissue (hypoxia).

Symptoms can vary greatly depending on the severity of the trauma and the area of the body that is injured.

Dr. Angela Tripp is a physiatrist who specializes in sports medicine and non-surgical orthopedics at SLUCare in St. Louis, MO. She also serves as an Assistant Professor in the Department of Orthopaedic Surgery at Saint Louis University School of Medicine.