RICE-principle

The immediate treatment of skeletal muscle injuries, or any soft tissue injury, is known as Rest, Ice, Compression, and Elevation (RICE). Important to know is that there is not a single, randomized clinical trial that proves the effectiveness of the RICE principle. However, there is scientific proof, derived from experimental studies, for the appropriateness of the different components of the concept.[1]

Rest

Today, we have quite a considerable amount of scientific, mostly experimental evidence to support this treatment approach. The most persuasive proof for the use of rest has been obtained from studies on the effects of immobilization on muscle healing. A short period of immobilisation is beneficial, but should be limited to the first few days after injury.[1] This allows the scar tissue to connect the injured muscle stumps to withstand contraction-induced forces without re-rupturing. By restricting the length of immobilisation to a period of less than a week, the adverse effects of immobility can be minimised.[2]

Ice

Despite its widespread clinical use, the precise physiological responses to therapeutic cooling have not been fully explored, and effective evidence-based treatment protocols are yet to be established.[3] However, it has been shown that the early use of cryotherapy is associated with a significantly smaller hematoma, less inflammation, and somewhat accelerated early regeneration.[2]

  • In the acute inflammatory phase, cryotherapy is thought to decrease oedema formation via induced vasoconstriction, and reduce secondary hypoxic damage.
  • During the later, sub-acute phase short periods of ice application have been used to produce a similar analgesic effect, thus facilitating earlier therapeutic exercise and allowing a quicker return to activity.[3] Based on available evidence, cryotherapy also seems to be effective in decreasing pain.[4]

Compression

Although compression reduces the intramuscular blood flow to the injured area, it is debatable whether compression applied immediately after the injury actually accelerates the healing of the injured skeletal muscle.[5] However, according to the prevailing belief, it is recommended that the combination of ice and compression be applied in shifts of 20 minutes, repeated at intervals of 30 to 60 minutes, result in a decrease in the intramuscular temperature and a 50% reduction in the intramuscular blood flow.[2]

Elevation

Finally, the rationale for the use of elevation is based on the basic principles of physiology and traumatology; the elevation of an injured extremity above the level of the heart results in a decrease in hydrostatic pressure and, subsequently, reduces the accumulation of interstitial fluid.[1] [2]

References

  1. 1.0 1.1 1.2 Tero A. H. Järvinen, Teppo L. N. Järvinen, Minna Kääriäinen, Hannu Kalimo and Markku Järvinen, Muscle Injuries : Biology and Treatment, The American Journal of Sports Medicine 2005 33: 745 Level of evidence : 2A
  2. 2.0 2.1 2.2 2.3 Järvinen TA, Järvinen TL, Kääriäinen M, Aärimaa V, Vaittinen S, Kalimo H, Järvinen M, Muscle injuries: optimising recovery, Best Pract Res Clin Rheumatol. 2007 Apr;21(2):317-31. Level of evidence : 5
  3. 3.0 3.1 Bleakley CM, O'Connor S, Tully MA, Rocke LG, Macauley DC, McDonough SM, The PRICE study (Protection Rest Ice Compression Elevation): design of a randomised controlled trial comparing standard versus cryokinetic ice applications in the management of acute ankle sprain, BMC Musculoskelet Disord. 2007 Dec 19;8:125. Level of evidence : 2B
  4. Hubbard TJ, Denegar CR, Does Cryotherapy Improve Outcomes With Soft Tissue Injury? J Athl Train. 2004 Sep;39(3):278-279. Level of evidence : 2A
  5. Thorsson 0, Lilja B, Nilsson P, Westlin N. Immediate external compression in the management of an acute muscle injury. Scand J Med Sci Sports 1997: 7: 182-190. Level of evidence : 2B