Monday, December 7, 2009

RICE - After an injury

R. I. C. E. (Rest, Ice, Compression, Elevation)

The acronym RICE, is an easy way to remember the four basic methods used to speed minor injury recovery (Rest, Ice, Compression, Elevation).

Less severe injuries as well as some over use injuries, may be rested by merely avoiding any activities, which use the affected body part. In order for a musculoskeletal injury to heal, it needs to be immobilized for 2-3 days following the injury. Using the injured "part" too early can increase haemorrhage, cause further damage to the area, and prolong recovery. Wraps, tape, splints, casts, canes and crutches can all help keep an injury immobilized.


The best line of defence in most acute, soft tissue injuries is the application of ICE. Ice decreases swelling, bleeding, spasm, pain and inflammation and should be applied within the first 24-72 hours after injury. Here's a brief review of the how, why and when of ICE therapy:
WHY ICE? Swelling causes a lack of oxygen to local tissues which creates cellular damage. Ice decreases swelling and bleeding by causing a constriction of blood vessels; thereby, minimizing the damage. Pain is relieved directly by its effect on pain receptors and indirectly by a decrease in swelling.

HOW LONG TO ICE? The amount of fat between the skin and the injured area and the depth of the injury determines how long you apply ice. Little fat? A minimum of 10 minutes will do. More fat? 20-30 minutes max. Brief applications until numbness is achieved are effective for conditions such as tendinitis, bursitis or ligament sprains. Longer durations are necessary for muscle strains. But be careful. Icing an area for too long can cause tissue damage.

Two to three daily treatments for tendinitis-type conditions or superficial muscle-strains; however, the greater the amount of pain and/or muscle spasm, the more frequent the applications. Depending on the severity of the injury, ice can be applied every 1-1 1/2 hrs.

Immediately after an injury, up to 72 hours, and for relief of pain and swelling associated with exercise.
Once the bleeding and swelling has subsided (usually within 72 hours), "heat", in the form of hot packs, hot towels, whirlpool baths, and ultrasound, can play an important part in injury rehabilitation. Heat increases blood flow and the "stretch ability" of tissues, decreases pain, muscle spasm, and joint stiffness, as well as promotes soft tissue repair.


For an acute injury, immediate compression is important. Direct external pressure applied to the injured area will help decrease haemorrhage and bleeding.
Compression can be applied during icing as well. An elastic wrap can be wrapped around the affected limb, securing the ice pack. Alternately, the wrap can be soaked in water and frozen.

Compression should be continued throughout the day. For difficult areas, such as around the bony areas of the ankle, pads can be cut and held in place with athletic tape and/or an elastic wrap. Compression should be removed at night and the affected area elevated above the heart.

Elevation also helps reduce internal bleeding and swelling. The injured area should be elevated above the level of the heart. This will decrease the bleeding, facilitate venous return, and prevent the pooling of fluids in the injured area. This is especially important at night when the body processes slow down.

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1 comment:

  1. Good article. I teach sports medicine and this is exactly what we go by.