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What does RICE therapy in post injury management mean?

RICE is a useful acronym for the medical practice of treating injuries to the soft tissues of the body. The letters in the acronym stand for Rest, Ice, Compression and Elevation. These are the four important elements of soft tissue treatment for any injury. This useful acronym was invented by Gabe Mirkin, who used it in his famous Sportsmedicine Book, which was published in 1978. Since then, the idea of RICE has been an important component of injury treatment.

The first stage: rest

RICE as a concept is a kind of first aid treatment, and a system which can be followed by anyone wanting to limit injuries and increase the rate of recovery. Following the principals of RICE will limit damage, manage any discomfort the injured person may feel and reduce any internal bleeding. The first step in the process is Rest. This means you must stop the activity which caused the injury immediately and rest the damaged limb. Rest is vital to repair the body, and adequate rest must be taken for 24 - 48 hours after injury, to give the body time to heal itself. If you do not rest, inflammation can grow worse, pain can continue and you might cause even more damage to the affected area.

One important part of the rest aspect of RICE is that rest should not be excessive. After an initial rest period, it is vital to get moving again slowly, to restore mobility effectively. If rest is too long, stiffness can ensue and it might take longer to get back to normal. The rest period should be long enough so that the pain subsides and the limb is more or less back to normal, but be careful not to stay immobile for too long.

The second stage: ice

The second stage of the RICE process of dealing with soft tissue injury is ice. This means adding ice to the affected limb to bring down any swelling that may have occurred. Inflammation can occur in the affected area, and the application of ice can bring this down and also help to relieve pain.

One tried and tested method is to apply ice to the area for 20 minutes during one hour. This gives 20 minutes of ice treatment and 40 minutes without ice. It is important to take care not to give skin frostbite with the ice pack and to avoid this, ice should be wrapped in a towel or other soft fibres to provide a suitable padded barrier between the bare ice and the skin. It is also important not to place the ice on the limb for longer than indicated, as this can actually have a detrimental effect.

The third stage: compression

Compression is the third stage of treatment for soft tissue injury. This aims to reduce the swelling of an inflamed limb by compressing the area with a bandage or other treatment. An elastic bandage (or compressive sleeve) should be used ideally, as this gives plenty of stretch, while still helping to keep the limb compressed. One example of this type of bandage is zinc oxide tape. The fit of the bandage should always be snug, but the stretch in the material should allow movement of the muscle beneath, when it flexes. To treat the legs, compression stockings are an alternative to a traditional stretch bandage. Graduated compression is ideal, as this allows the bandage to have varied compressive qualities, depending on where the limb is in relation to the heart - the closer it is, the higher the degree of compression. Compression stockings are used effectively in hospitals after operations and are ideal for use in RICE treatment.

It is also possible to combine the ice and compression parts of RICE, to create a cold compression, using a compressive bandage covered in ice to reduce swelling in two ways. This treatment is ideal for treating injuries such as sprains and pulled muscles.

The fourth stage: elevation

Another method used in hospitals for damaged limbs is elevation. Elevating the limb reduces swelling in the affected body part, by increasing the return of blood back down the limb into the circulatory system. This reduces the risk of blood pooling in the limb and also reduces pain and inflammation. As with the other parts of the RICE treatment, elevation helps to reduce blood flow to the affected area.

Alternatives to RICE include MEAT

Some people think that sometimes an alternative therapy should be used, to keep blood flow in the affected area, for injuries such as damage to tendons and ligaments. While RICE is ideal for muscle injuries, the more appropriate treatment to follow to treat tendons and ligaments is the MEAT acronym, which stands for Movement, Exercise, Analgesics, Treatments. There should be controlled movement in the affected area to stimulate blood flow, with exercise also important for the same reason.

Diagram of a torn anterior cruciate ligament

The third part of MEAT is analgesics, which means non-anti-inflammatory medicines. So instead of ibuprofen, people should use natural analgesics such as papain, which can be found in papayas, and bromelain which can be found in pineapples. Finally the treatment part of the acronym MEAT means getting appropriate treatment from a registered physiotherapist.

Avoid negative treatments with HARM

In contrast with the RICE and MEAT treatments, the acronym HARM explains what to avoid when treating soft tissue injuries. HARM stands for Heat, Alcohol, Running, Massage. Firstly, heat will increase blood circulation to the affected area, which is what you are trying to avoid with RICE. However, this might be desirable to a controlled extent, if following MEAT. Secondly, alcohol should always be avoided, as it dilates the blood vessels and can increase pain. Always avoid drinking any alcohol when suffering with an injury. Running and vigorous exercise should also be avoided when suffering from an injury, as not only is this potentially damaging to the weakened limbs, but it also increases blood flow. Finally, massage should be avoided immediately following injury, as this will stimulate blood flow to the affected area. Although massage can be very useful in the later stages of recovering from an injury, it should always be avoided in the early stages, as it can make the injury worse by stimulating blood flow directly around the affected limb.

The acronym HARM is especially useful, as it spells out a word that makes it obvious this is a negative practice to follow. These things should be avoided in the first 72 hours after sustaining an injury. However, after this initial period, some of these HARM activities could be beneficial in your recovery. One of the most important is the Running (or Exercise) part of the acronym, which, although it’s damaging to an injured limb in the short term, is vital in the longer term, to get back on track and regain full movement in the affected area.

The importance of movement to health

In fact, a sedentary lifestyle is one of the most harmful aspects of modern life for many people. In some studies, people were shown to lose almost a third of their muscle strength in only two weeks of inactivity. This can be shown if you have to rest in bed with an illness - you will always feel weak when you start moving around again. Movement is vital for a healthy body. So follow the RICE method and avoid the HARM actions for the early part of an injury, but do not delay getting back on your feet after 72 hours following a regular soft tissue injury. If you’re unsure whether you are ready to return to regular movement, always seek the advice of a doctor.