Immediately after an acute injury (e.g. ligament sprain such as twisting an ankle, or a muscle strain) the body responds by triggering an inflammatory response lasting 48-72 hours, which lays the ground work for the healing process. The inflammatory response is characterized by pain, heat (localized warmth at theinjury site), redness, and swelling. It is important to help guide the inflammatory process in order to prevent it from creating additional tissue damage.

 To help guide the inflammatory process after injury it is beneficial to implement the PIER principle.


Pressure – is the most important aspect to controlling swelling and inflammation (e.g. applying a tensor bandage to the injured area).

Ice – no heat at this stage! Start with 10-15 min and make sure the tissue rewarms completely before reapplying. Cold helps to decrease the sensitivity of the injury and minimizes excess tissue damage from the inflammatory process.

Elevate – elevating the injured area above the level of the heart will assist in drainage of swelling.

Rest – respect the injury and allow the tissue to heal – at times,active rest is best to help guide and promote the healing process – this is where your therapist can help!

When an injury is sustained it is important to consult with your physician, athletic therapist, or physiotherapist as soon as possible to determine the severity and nature of the tissue damage. If the pain is significant or gets worse over a short period of time it is important to seek medical attention immediately and may require a trip to the local emergency room for diagnosis.