R.I.C.E (Rest, Ice, Compression, Elevation) is one of the most recommended first aid therapeutic treatment for acute musculoskeletal injuries such as sprains and strains. It is a common method used in the management of injuries and is used primarily to help reduced inflammation and the associated swelling as welling as providing basic pain relief. As mentioned above the main aim of R.I.C.E to control swelling and to aid recovery time. It should be administered as soon as possible after the injury. This will results in decreased pain, inflammation, muscle spasms, swelling and tissue damage. (3) The four components of R.I.C.E. therapy can be carried out together, separately or in any combination of components from the four elements of the technique.
It is important after an acute injury to rest the affected area to protect it from further injury. The area should be protected from excessive stress but not allowed to be completely inactive. Complete inactivity will result in excessive decreases in strength and mobility of the affected soft tissues, and promote increased swelling. The load must be within the capacity of the affected tissue, when the load is higher than the capacity it may cause further injury or negatively affect the recovery of the affected tissue. It is important to determine the appropriate amount of stress the tissues can handle and ensure these are not exceeded in order to promote a faster recovery. (2,5)
Ice therapy, also know as cryotherapy, is the application of cold as a therapeutic modality. The cold stimulates vasoconstriction of the blood vessel in the area being iced. This reduces the swelling and inflammation by limiting the amount of fluid able to perfuse into the soft tissue surrounding the injury. It also numbs the affected area by decreasing the proprogation of nocioceptive neural stimuli to the brain to reduce pain and muscle spasms. However there are both positive and negative aspects to cryotherapy:
- Decrease in local metabolism
- Low enzymatic activity
- Less oxygen consumption
- Reduced flexibility because cold provides stiffness and reduced elasticity of the connective tissue of the muscles
- Decreases the amount of bleeding by vasoconstriction into the injury site and so lessens swelling
- Reduces pain
- Reduces muscle spasm
In the acute stages of injury the positive effects of cryotherapy outweighthe negative effects, and allows for a degree of control over the inflammatory reaction. However, with the initial inflammatory reaction of the injured soft tissue reduced the negative aspects of cryotherapy will impede the recovery of the tissue.
Apply ice for 15 a 20 minutes periods every couple of hours in the first fourty-eight hours after the injury occured. The ice must be wrapped in a damp towel or cloth to prevent superficial nerve or skin damage caused by over exposure to the ice.
Apply caution when using cryptherapy on people who are hypersensitive to cold such as anyone with Raynaud’s syndrome, diabetes, cold urticaria, paroxysmal cold hemoglobulinuria or have a circulatory insufficiency.
Ice VS Heat
Ice should be used initially to minimise the inflammatory reaction post acute injury. After 72 hours, the initial chemical inflammatory reaction will decrease and the effects of heat will out weight the effects of ice. Heat will result in increased circulation, relaxes muscle tension and reduced joint stiffness. In addition it will also help to prepare tissues for rehabilitation. (1,2,4,5)
Compression of the injured area helps to immobilize and protect the joint. It also helps to reduce swelling in the area by increasing the pressure within the tissues this results in decreased perfusion of the soft tissue, which help to prevent excessive swelling. Ace bandage, brace or tape can be used as compression devices.
• Note: When the compression is to tight it can hinder the bloodcirculation and it can cause pain, decreased blood flow and/or neurological signs and symptoms to the compressed tissue or tissues distal to it.(5)
The injured area must immediately be raised, preferably to a level above the heart. This allows gravity to drain the excess fluid from around the injured tissue back to the central circulation, resulting in decreased swelling. As the pressure in the injured area is reduced, this will reduce pain and allow for transport of cellular waste products towards the heart which helps the recovery of the tissue by re-establishing the cellular and extracellular homeostasis. (4)
1. ↑KENNETH L. KNIGHT, 1995, Cryotherapy in sport injury managment, Human Kinetics, Champaign, 273p.
2. ↑ F. MICHAEL GLOTH, 2011 , Handbook of pain relief in older adults: an evidence-based approach, second edition, New York, Humana Press, 210p.
3. ↑ Louise Roach, What is rice?, [online] Topend Sports, The Sport and Science Resource. Perth, Australia. Available from: http://www.topendsports.com/medicine/rice.htm
4. ↑RICE,[online] Univeristy of Iowa Hospitals and clinics, Iowa. Available from: http://www.uihealthcare.com/topics/prepareemergencies/prep4922.html
5. ↑ RICE, Sports injury clinic. Available from: http://www.sportsinjuryclinic.net/cold_therapy/cold_therapy.php
Author: Frederik Töpke, May 2011
Peer Reviewed: Daniel Quinn, September 2014