RICE (Rest/Ice/Compression/Elevation) Treatment for Injuries

RICE (Rest/Ice/Compression/Elevation) treatment is a system of soft tissue injury treatment that is both a first aid application as well as an ongoing approach to injury management. The individual components of RICE have been well recognized for many years as effective in managing athletic injury; since the 1970s, sport science has endorsed the RICE method as the most effective method to deal with ankle and knee sprains, muscle and tendon pulls or strains, and the bruising that results from the physical contact of sport.

The component of rest of RICE begins at the time of the injury. The injured player must be removed from competition to permit an assessment of the nature and extent of the injury; many types of musculoskeletal injuries become worse if the athlete is permitted to play through the problem. In many cases, the use of topical painkillers to permit continued play will deaden the athlete's ability to sense further physical injury. When the injury is determined to be sufficiently serious that continued play would likely cause further structural damage, the athlete should immediately be subjected to the second part of RICE, the application of ice or a similar cold product to the site of the injury is recommended.

Damage to the soft tissues of the body will invariably create swelling in these structures. Swelling is caused by the release of intracellular fluid at the point of the injury, coupled with an increase in blood flow to the site. Swelling will slow the healing process, as it is the body's natural mechanism to impair joint movement as a signal to the body not to use the injured joint. If these natural healing processes took priority, the recovery from injuries such as an ankle sprain or a twisted knee (a sprain of the knee ligaments) would be slow. The application of ice to the area of swelling serves to constrict the flow of blood to the affected area, thus reducing swelling. The ice has a secondary effect of deadening the pain receptors in the area of the affected structure.

There are considerable differences in scientific opinion as to how and for how long ice may be applied to a soft tissue injury. The nature, location, and the extent of the injury are significant factors; ice applied to a bony area such as the knee has a less insulating soft tissue beneath the skin than a contusion (bruise) sustained to the thigh. As a general guideline, the less soft tissue that is present at the injury site, the shorter the period that the area should be iced; 10 minutes would be a minimum application, with 25 to 30 minutes representing the upper end of a safe icing range. The application of ice for too long a period can cause permanent damage to the underlying tissue not unlike that caused by frostbite. Further, some chemical ice products available for sports first aid purposes are colder than ice, and the application time must be adjusted accordingly.

Ice can be applied on a regular basis after the onset of the injury. For a tendinitis injury such as jumper's knee, a strain often experienced by jump sport athletes and basketball players, the injury site might be iced three times per day. When the athlete has sustained a more serious ankle sprain, the joint could be iced every two hours throughout the day. Ice will typically be most effective within the first 72 hours of the occurrence of a soft tissue injury.

The third RICE element, compression, is the physical application of pressure to the location of a soft tissue injury. Compression is useful as a first aid treatment, as the application of pressure will reduce the effect of any internal bleeding or swelling that may result from the injury. Compression has two separate roles in the course of RICE treatment: first, as a companion to the icing of the injury, and second, as the day-to-day maintenance of the injured structure. Elastic bandages and athletic tape are both used to provide compression, as are sleeves that are designed to fit over an entire joint and surrounding limb, such as in knee or elbow injuries.

In ideal circumstances, the injured portion of the body will be maintained at an elevation above that of the heart. Such elevation serves to both reduce swelling as well as to promote the healthy action of the veins of the cardiovascular system to return blood from the injured area to the heart (a process known as venous return), which counters the pooling of blood near the injury.

RICE works best when it is implemented immediately from the time of injury. However, even the delayed application of the treatment (for example, the day after the injury occurred) will promote better healing than if the injury is untreated. Various studies of recovery time experienced by athletes who sustained ankle sprains suggest that RICE treatment reduces time lost to injury by over 40%, as well as contributing to a reduction in scar tissue formation.

SEE ALSO Ankle sprains; Calf strain or pull; First aid kits for sports; Knee injuries; Musculoskeletal injuries; Quadriceps pulls and tears; Sprains and strains.