POLICE and NO HARM Principles
Understanding the POLICE and NO HARM Principles in Fracture and Acute Injury Management
In sports medicine, the POLICE and NO HARM principles are complementary, and often used together as guidelines of what to do and not to do, especially in the first 2-3 days of an injury.
The POLICE principle is a recognised framework and a first line strategy used in the early management of musculoskeletal injuries, including fractures and soft tissue trauma. Developed as an update to the previous RICE approach (Rest, Ice, Compression, Elevation), the POLICE method includes the concept of Optimal Loading in its approach. The approach can be useful during the early stages of recovery and is best applied under guidance from your fracture clinic team or physiotherapist.
The acronym stands for:
- Protect – this step involves immobilising the injured part using slings, splints, boots, or casts. Our clinicians will guide you on how long to protect the area and what devices to use.
- Optimal Loading – optimal loading involves gradual reintroduction of weight-bearing and movement to encourage tissue repair. In fracture management, this is done cautiously to prevent any further damage, and only when medically deemed safe by your treating team or physiotherapist.
- Ice – ice can help manage swelling and pain, especially in the first 48–72 hours after the injury. A cold ice pack can be applied for 15-20 minutes, however, direct contact with the skin must be avoided.
- Compression – elastic bandages and supporting wraps are used in applying compression to reduce swelling and promote blood circulation. However, compression must only be applied if your doctor approves, as it may not be appropriate for all types of fractures.
- Elevation – elevating the limb above heart level where possible, especially in the early days of the injury, can help reduce swelling and speed up tissue recovery by draining fluids away from the injured area.
Potential benefits of POLICE principle:
- Reduction in pain and swelling
- Improved function and circulation
- Prevention of stiffness and muscle wasting
- A safe and supported return to activity
In sports medicine and physiotherapy, the NO HARM principle offers a guideline for what not to do in the first 3 days of an acute injury, such as a muscle tear, sprain, or strain. These actions can worsen swelling, tissue damage, and bleeding in some cases.
No Heat – Avoid hot water or hot baths, heat packs, or saunas—heat increases blood flow, which can worsen swelling and bleeding.
No Alcohol – Alcohol intake can lead to increase in bleeding and swelling. It may also reduce awareness of pain severity, and compromise the healing process.
No Running – Avoid running, exercise or excessive activity, as repeated movement of the injured area can worsen the injury.
No Massage – Massaging your injured area can increase internal bleeding and swelling. Its best to discuss with your physiotherapist for correct guidance
Can I start moving the limb before the fracture heals?
Not without guidance. Moving or using the injured limb too early can delay healing or cause complications. Once your fracture is stabilised, gentle movements may be introduced under supervision to prevent stiffness and support circulation.
Is POLICE used instead of seeing a doctor?
No. The POLICE principle is a supportive self-care guideline and should never replace professional assessment and treatment. Fractures require medical management to ensure correct healing and avoid long-term issues.
How long should I follow POLICE after an injury?
The timeframe will depend on the type of injury and stage of healing. Ice and elevation are typically used for the first few days, while protection and optimal loading may continue for several weeks. Your fracture clinic team will provide an individualised plan.
Who can advise me on using the POLICE principle safely?
Guidance should be sought from qualified healthcare professionals including your orthopaedic doctor, physiotherapist, or nursing staff. They will assess your injury and provide safe instructions tailored to your recovery.
