Injury timeframes

Timeframe of disorder 

The timeframe or stage of the disorder is obviously important as it will necessitate different priorities in management. For example, an acute injury (e.g., a kick to the calf causing bruising) will need the usual case (ie, compression, elevation etc. – more on this later). However, chronic pain (e.g., back pain that worsens with increased stress, poor sleep and long days at work) will necessitate different management. 

Acute pain

Acute pain occurs suddenly and usually has a specific cause or mechanism. It describes a time-limited response to injury. Examples include, 

• Ankle sprain jogging 
• Bruise from a punch 
• Broken bone from a throw 

Acute pain could also occur without an obvious mechanism or tissue damage. For example, 

• Arthritis flare-up 
• Wry neck (acute torticollis)

Implications for management include, 

1. Recognising not all acute pain is the same and is influenced by other components. E.g., tissue damage (e.g., sprained ankle) needs to follow the PRICE principle. Whereas acute neck pain with associated headaches, stress, sleep deprivation and prolonged studying (ie., no tissue damage) obviously needs, not PRICE, but symptom relief and management of underlying contributors. 
2. Strategies for immediate pain relief (e.g., hot/cold, [oral pain relief as directed by your doctor], etc.)
3. Reducing further damage while remaining as active as possible (e.g., taping, bracing, tubigrip etc.)
4. Strategies to reduce chance of ongoing or worsening sensitivity (e.g., avoiding physical provocation [i.e., avoiding doing too much/breaking pain rules, or doing too little], and avoiding psychosocial provocation [e.g., unhelpful beliefs])
5. Reassurance (e.g., avoiding catastrophisation [making a catastrophe out of a bad situation], positive reframing of the situation, etc.)

Sub-acute pain

Sub-acute pain describes either:

• the transitionary period between the occurrence of acute pain (e.g., when you roll your ankle) to when your tissue has recovered (e.g., when your ankle has healed), or 
• the transitionary period between a flare-up (e.g., painful achilles after a run) to when the symptoms subside (e.g., when your achilles is no longer painful). 

Implications for management include,

1. Slow, gradual reconditioning of the functional capacity of the painful tissue 
2. Seeking pain-relieving strategies to assist active interventions (as per acute pain above)
3. Remaining as active as possible 

Recurrent pain 

Recurrent disorders are when you experience a new episode of an old problem. Sometimes this means, 

• a flare-up of a constantly ‘niggly’ injury, or 
• a return of pain after a period of being pain-free. 

Implications for management include, 

1. Seeking pain-relieving strategies (as per acute pain above)
2. Actively investigating the potential contributing factors
3. Remaining as active as possible

Persistent/chronic pain

Chronic pain is pain that persists beyond the normal timeframe, often 3-6 months. There may be some overlap between a chronic condition (e.g., chronic low back pain) that also has recurrent episodes (e.g. a low back pain flare-up after a heavy weights session). 

Implications for management include, 

1. Actively investigating the potential contributing factors as per the assessment framework (Figure 3)
2. Remaining vigilant for red flags that may be present and contributing to the persistent nature of the pain