RICE (medicine)

Last updated

RICE
RICE medicine.svg
Rest, Ice, Compression, and Elevation

RICE is a mnemonic acronym for the four elements of a treatment regimen that was once recommended for soft tissue injuries: rest, ice, compression, and elevation. [1] It was considered a first-aid treatment rather than a cure and aimed to control inflammation. [2] It was thought that the reduction in pain and swelling that occurred as a result of decreased inflammation helped with healing. [1] The protocol was often used to treat sprains, strains, cuts, bruises, and other similar injuries. [3] Ice has been used for injuries since at least the 1960s, in a case where a 12-year-old boy needed to have a limb reattached. The limb was preserved before surgery by using ice. As news of the successful operation spread, the use of ice to treat acute injuries became common. [4]

Contents

The mnemonic was introduced by Dr. Gabe Mirkin in 1978. [5] He withdrew his support of this regimen in 2014 after learning of the role of inflammation in the healing process. [6] The implementation of RICE for soft tissue injuries as described by Dr. Mirkin is no longer recommended, as there is not enough research on the efficacy of RICE in the promotion of healing. [2] In fact, many components of the protocol have since been shown to impair or delay healing by inhibiting inflammation. [2] [3] [7] Early rehabilitation is now the recommendation to promote healing. [3] [8] Ice, compression, and elevation may have roles in decreasing swelling and pain, but have not shown to help with healing an injury. [2] [7] [9]

There are different variations of the protocol, which may emphasize additional protective actions. However, these variations similarly lack sufficient evidence to be broadly recommended. [9] Examples include PRICE, POLICE, and PEACE & LOVE. [9] [10] [11] [12]

Primary four terms

Rest

Rest refers to limiting the use of an injured area. It was once recommended to rest an injury for up to 2 days or until it was no longer painful to use. [1] It was intended to reduce inflammation and to prevent further injury. [2] Blood supply is an important component of inflammation. By resting an injury, blood flow to the area is reduced, which reduces the swelling and pain associated with inflammation. [13] The early stages of healing involve microscopic scaffolding that is built upon to repair an injury. These scaffolds are relatively weak until reinforced by later stages of healing. [14] Early and aggressive movement could potentially disrupt the scaffolds, delaying healing or worsen an existing injury. [2]

Although rest may provide some benefit immediately after an injury, returning to movement early has been shown to be better at reducing pain and encouraging healing. [3] [8]

Ice

Ice and Elevation
Ice & Elevate Leg Part 1 Ice & Elevate Leg Part 1.png
Ice & Elevate Leg Part 1
Ice being applied to a leg propped on a pillow for elevation

Ice refers to the application of cold objects to an injury, such as ice, an icepack, frozen vegetables, etc. [1] It was meant to reduce swelling and inflammation by vasoconstriction. [15] However, adequate blood flow is essential in allowing cells and signals from our immune system to reach injured areas. By reducing the entry of these cells and signals to the injury, healing can be delayed, or possibly inhibited. [7] [16] [15] [17]

The current research supports the role of ice in temporary pain relief, but there is little evidence supporting the use of ice to aid in healing, or even swelling reduction. [7] Further research is needed to further understand how ice should be applied. At this time, due to the lack of evidence, there is no consensus on the ideal temperature ranges, time frames, application methods, or patient populations when using ice on a soft tissue injury. [16] Most studies use icing protocols of intermittent 10-20 minute applications, several times a day for the first few days following an injury. [7]

Compression

Compression refers to wearing bandages, stockings, braces, or similar devices to apply pressure over a localized area to reduce swelling and stop bleeding. [1] [2] The increased pressure pushes fluids into the blood vessels to drain away from the area. [7] The effects of compression on swelling reduction are temporary and gravity-dependent. [18]

Although studies have demonstrated the effects of compression on swelling, there is little evidence to support the use of compression to promote healing. [7] [9] When considering the use of compression, the evidence supports the use of elastic bandages with Intermittent Pneumatic Compression (IPC) to reduce swelling and pain, while improving range of motion. [2]

Elevation

Elevation refers to keeping an injury above the level of the heart, such as propping up a leg with pillows. [1] The goal was to reduce swelling by using gravity to encourage blood return from the swollen area back to the heart. [18] The reduction in swelling could improve pain by relieving pressure from the area. The effects of elevation on swelling have been shown to be temporary, as swelling returns when the injured area is no longer elevated. [18]

However, at this time there is little evidence to support that elevation promotes healing. [2]

Current support

Dr. Gabe Mirkin has since recanted his support for the regimen. [6] In 2015 he wrote:

Coaches have used my 'RICE' guideline for decades, but now it appears that both ice and complete rest may delay healing, instead of helping. The reasoning for this lies within the natural healing process. When an injury is created the body has to go through a very specific sequence to heal said injuries. For the next step the step prior has to be completed. The first step in the sequence is inflammation. If you use ice to reduce inflammation, it is only going to slow the healing process because inflammation needs to be complete for the sequence to keep progressing. [19] In a recent study, athletes were told to exercise so intensely that they developed severe muscle damage that caused extensive muscle soreness. Although cooling delayed swelling, it did not hasten recovery from this muscle damage.

Rest may play a role immediately after an injury, but the evidence supports early mobilization to promote healing. [9] Due to the inhibitory effects of ice on mounting a proper inflammatory response, a protocol including extended applications of ice could delay the body's attempt at healing. [16] [17] While it is unclear what the effects of elevation and compression are on the healing process, reduction of swelling is a transient effect and returns when the injury is returned to a lower, gravity-dependent position. [2] [18]

Currently, the RICE protocol is no longer recommended and has given way to other protocols for treating soft tissue injuries. Most recently, in 2019 the mnemonic "PEACE & LOVE" was coined by Blaise Dubois. The PEACE component stands for protection, elevation, avoid anti-inflammatories, compression, and education. It guides the treatment of acute soft tissue injuries. The LOVE component stands for load, optimism, vascularization, and exercise. It guides the treatment for the sub-chronic and chronic management of soft tissue injuries. [12] There is also evidence that points towards using heat to treat acute and soft tissue injuries. As stated before, ice is only going to restrict blood flow, and in turn, slow the healing process. The use of heat will open up the blood vessels in the affected area. This will help speed up the healing process as well as reduce the possibility of persistent stagnation in the affected area and reduce the risk of future re-injury. [15]

Variations

Variations of the acronym are sometimes used to emphasize additional steps that should be taken. These include:

See also

Related Research Articles

<span class="mw-page-title-main">Sprain</span> Damage to one or more ligaments in a joint

A sprain is a soft tissue injury of the ligaments within a joint, often caused by a sudden movement abruptly forcing the joint to exceed its functional range of motion. Ligaments are tough, inelastic fibers made of collagen that connect two or more bones to form a joint and are important for joint stability and proprioception, which is the body's sense of limb position and movement. Sprains may be mild, moderate, or severe, with the latter two classes involving some degree of tearing of the ligament. Sprains can occur at any joint but most commonly occur in the ankle, knee, or wrist. An equivalent injury to a muscle or tendon is known as a strain.

<span class="mw-page-title-main">Bruise</span> Type of localized bleeding in tissues outside blood vessels

A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur close enough to the epidermis such that the bleeding causes a visible discoloration. The bruise then remains visible until the blood is either absorbed by tissues or cleared by immune system action. Bruises which do not blanch under pressure can involve capillaries at the level of skin, subcutaneous tissue, muscle, or bone.

<span class="mw-page-title-main">Back injury</span> Damage or wear to bones, muscles or other tissues of the back

Back injuries result from damage, wear, or trauma to the bones, muscles, or other tissues of the back. Common back injuries include sprains and strains, herniated discs, and fractured vertebrae. The lumbar spine is often the site of back pain. The area is susceptible because of its flexibility and the amount of body weight it regularly bears. It is estimated that low-back pain may affect as much as 80 to 90 percent of the general population in the United States.

<span class="mw-page-title-main">Achilles tendinitis</span> Medical condition of the ankle and heel

Achilles tendinitis, also known as achilles tendinopathy, occurs when the Achilles tendon, found at the back of the ankle, becomes sore. Achilles tendinopathy is accompanied by alterations in the tendon's structure and mechanical properties. The most common symptoms are pain and swelling around the affected tendon. The pain is typically worse at the start of exercise and decreases thereafter. Stiffness of the ankle may also be present. Onset is generally gradual.

Cryotherapy, sometimes known as cold therapy, is the local or general use of low temperatures in medical therapy. Cryotherapy may be used to treat a variety of tissue lesions. The most prominent use of the term refers to the surgical treatment, specifically known as cryosurgery or cryoablation. Cryosurgery is the application of extremely low temperatures to destroy abnormal or diseased tissue and is used most commonly to treat skin conditions.

A soft tissue injury is the damage of muscles, ligaments and tendons throughout the body. Common soft tissue injuries usually occur from a sprain, strain, a one-off blow resulting in a contusion or overuse of a particular part of the body. Soft tissue injuries can result in pain, swelling, bruising and loss of function.

<span class="mw-page-title-main">Patellar tendinitis</span> Human disease

Patellar tendinitis, also known as jumper's knee, is an overuse injury of the tendon that straightens the knee. Symptoms include pain in the front of the knee. Typically the pain and tenderness is at the lower part of the kneecap, though the upper part may also be affected. Generally there is no pain when the person is at rest. Complications may include patellar tendon rupture.

<span class="mw-page-title-main">Strain (injury)</span> Injury due to slight tearing of a muscle or tendon

A strain is an acute or chronic soft tissue injury that occurs to a muscle, tendon, or both. The equivalent injury to a ligament is a sprain. Generally, the muscle or tendon overstretches and partially tears, under more physical stress than it can withstand, often from a sudden increase in duration, intensity, or frequency of an activity. Strains most commonly occur in the foot, leg, or back. Immediate treatment typically includes four steps abbreviated as R.I.C.E.: rest, ice, compression, elevation.

Heat therapy, also called thermotherapy, is the use of heat in therapy, such as for pain relief and health. It can take the form of a hot cloth, hot water bottle, ultrasound, heating pad, hydrocollator packs, whirlpool baths, cordless FIR heat therapy wraps, and others. It can be beneficial to those with arthritis and stiff muscles and injuries to the deep tissue of the skin. Heat may be an effective self-care treatment for conditions like rheumatoid arthritis.

<span class="mw-page-title-main">Sprained ankle</span> Medical condition

A sprained ankle is an injury where sprain occurs on one or more ligaments of the ankle. It is the most commonly occurring injury in sports, mainly in ball sports such as basketball, volleyball, football, and tennis.

Cold compression therapy, also known as hilotherapy, combines two of the principles of rest, ice, compression, elevation to reduce pain and swelling from a sports or activity injury to soft tissues and is recommended by orthopedic surgeons following surgery. The therapy is especially useful for sprains, strains, pulled muscles and pulled ligaments.

Degloving occurs when skin and the fat below it, the subcutaneous tissue, are torn away from the underlying anatomical structures they are normally attached to. Normally the subcutaneous tissue layer is attached to the fibrous layer that covers muscles known as deep fascia.

Therapeutic ultrasound refers generally to any type of ultrasonic procedure that uses ultrasound for therapeutic benefit. Physiotherapeutic ultrasound was introduced into clinical practice in the 1950s, with lithotripsy introduced in the 1980s. Others are at various stages in transitioning from research to clinical use: HIFU, targeted ultrasound drug delivery, trans-dermal ultrasound drug delivery, ultrasound hemostasis, cancer therapy, and ultrasound assisted thrombolysis It may use focused ultrasound or unfocused ultrasound.

<span class="mw-page-title-main">Jammed finger</span> Medical condition

Jammed finger is a colloquialism referring to a variety of injuries to the joints of the fingers, resulting from axial loading beyond that which the ligaments can withstand. Common parts of the finger susceptible to this type of injury are ligaments, joints, and bones. The severity of the damage to the finger increases with the magnitude of the force exerted by the external object on the fingertip. Toes may become jammed as well, with similar results.

Contrast bath therapy is a form of treatment where a limb or the entire body is immersed in hot water followed by the immediate immersion of the limb or body in cold ice water. This procedure is repeated several times, alternating hot and cold. The only evidence of benefit is anecdotal and no plausible mechanism has been confirmed.

<span class="mw-page-title-main">Pulled hamstring</span> Medical condition

Straining of the hamstring, also known as a pulled hamstring, is defined as an excessive stretch or tear of muscle fibers and related tissues. Hamstring injuries are common in athletes participating in many sports. Track and field athletes are particularly at risk, as hamstring injuries have been estimated to make up 29% of all injuries in sprinters. Hamstring injuries can also come with a hip injury from sprinting. Symptoms for a hip injury are pain, aching and discomfort while running or any physical exercise.

A high ankle sprain, also known as a syndesmotic ankle sprain (SAS), is a sprain of the syndesmotic ligaments that connect the tibia and fibula in the lower leg, thereby creating a mortise and tenon joint for the ankle. High ankle sprains are described as high because they are located above the ankle. They comprise approximately 15% of all ankle sprains. Unlike the common lateral ankle sprains, when ligaments around the ankle are injured through an inward twisting, high ankle sprains are caused when the lower leg and foot externally rotates.

<span class="mw-page-title-main">Musculoskeletal injury</span> Medical condition

Musculoskeletal injury refers to damage of muscular or skeletal systems, which is usually due to a strenuous activity and includes damage to skeletal muscles, bones, tendons, joints, ligaments, and other affected soft tissues. In one study, roughly 25% of approximately 6300 adults received a musculoskeletal injury of some sort within 12 months—of which 83% were activity-related. Musculoskeletal injury spans into a large variety of medical specialties including orthopedic surgery, sports medicine, emergency medicine and rheumatology.

Running injuries affect about half of runners annually. The frequencies of various RRI depend on the type of running, such as speed and mileage. Some injuries are acute, caused by sudden overstress, such as side stitch, strains, and sprains. Many of the common injuries that affect runners are chronic, developing over longer periods as the result of overuse. Common overuse injuries include shin splints, stress fractures, Achilles tendinitis, Iliotibial band syndrome, Patellofemoral pain, and plantar fasciitis.

<span class="mw-page-title-main">Ankle problems</span> Medical condition

Ankle problems occur frequently, having symptoms of pain or discomfort in the ankles.

References

  1. 1 2 3 4 5 6 "Sports Medicine Advisor 2005.4: RICE: Rest, Ice, Compression, and Elevation for Injuries". Archived from the original on 11 September 2007. Retrieved 15 August 2007.
  2. 1 2 3 4 5 6 7 8 9 10 van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM (2012). "What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?". Journal of Athletic Training. 47 (4): 435–43. doi:10.4085/1062-6050-47.4.14. PMC   3396304 . PMID   22889660.
  3. 1 2 3 4 Bayer, Monika L.; Mackey, Abigail; Magnusson, S. Peter; Krogsgaard, Michael R.; Kjær, Michael (18 February 2019). "[Treatment of acute muscle injuries]". Ugeskrift for Laeger. 181 (8): V11180753. ISSN   1603-6824. PMID   30821238.
  4. ↑ Wojciechowksi, Andrew. "Why You Shouldn't Ice An Injury – the RICE Method Myth". Correct Toes. Correct Toes. Retrieved 18 June 2023.
  5. ↑ Mirkin, G. (1981). Sports-medicine book. Boston: Little, Brown. ISBN   978-0316574365.
  6. 1 2 Mirkin, Dr Gabe (16 September 2015). "Why Ice Delays Recovery | Dr. Gabe Mirkin on Health" . Retrieved 5 December 2022.
  7. 1 2 3 4 5 6 7 Scialoia, Domenic; Swartzendruber, Adam J. (30 October 2020). "The R.I.C.E Protocol is a MYTH: A Review and Recommendations". The Sport Journal. 24.
  8. 1 2 Tiemstra, Jeffrey D. (15 June 2012). "Update on acute ankle sprains". American Family Physician. 85 (12): 1170–1176. ISSN   1532-0650. PMID   22962897.
  9. 1 2 3 4 5 6 C M, Bleakley (2012). "PRICE needs updating, should we call the POLICE?". British Journal of Sports Medicine. 46 (4). BMJ: 220–221. doi: 10.1136/bjsports-2011-090297 . PMID   21903616. S2CID   41536790 . Retrieved 5 March 2012.
  10. 1 2 Ivins D (2006). "Acute ankle sprain: an update". American Family Physician. 74 (10): 1714–20. PMID   17137000.
  11. 1 2 Bleakley CM, O'Connor S, Tully MA, Rocke LG, Macauley DC, McDonough SM (2007). "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 [ISRCTN13903946]". BMC Musculoskelet Disord. 8: 125. doi: 10.1186/1471-2474-8-125 . PMC   2228299 . PMID   18093299.
  12. 1 2 3 Dubois, Blaise; Esculier, Jean-Francois (3 August 2019). "Soft-tissue injuries simply need PEACE and LOVE". British Journal of Sports Medicine. 54 (2): 72–73. doi: 10.1136/bjsports-2019-101253 . ISSN   1473-0480. PMID   31377722. S2CID   199438679.
  13. ↑ Pober, JS; Sessa, WC (23 October 2014). "Inflammation and the blood microvascular system". Cold Spring Harbor Perspectives in Biology. 7 (1): a016345. doi:10.1101/cshperspect.a016345. PMC   4292166 . PMID   25384307.
  14. ↑ Wallace, Heather A.; Basehore, Brandon M.; Zito, Patrick M. (2022), "Wound Healing Phases", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   29262065 , retrieved 5 December 2022
  15. 1 2 3 Bleakley C, McDonough S, MacAuley D (1 January 2004). "The Use of Ice in the Treatment of Acute Soft-Tissue Injury: A Systematic Review of Randomized Controlled Trials". The American Journal of Sports Medicine. 32 (1): 251–261. doi:10.1177/0363546503260757. ISSN   0363-5465. PMID   14754753. S2CID   23999521.
  16. 1 2 3 Wang, Zi-Ru; Ni, Guo-Xin (16 June 2021). "Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture?". World Journal of Clinical Cases. 9 (17): 4116–4122. doi: 10.12998/wjcc.v9.i17.4116 . ISSN   2307-8960. PMC   8173427 . PMID   34141774.
  17. 1 2 Takagi, Ryo; Fujita, Naoto; Arakawa, Takamitsu; Kawada, Shigeo; Ishii, Naokata; Miki, Akinori (1 February 2011). "Influence of icing on muscle regeneration after crush injury to skeletal muscles in rats". Journal of Applied Physiology. 110 (2): 382–388. doi:10.1152/japplphysiol.01187.2010. ISSN   1522-1601. PMID   21164157.
  18. 1 2 3 4 Tsang, Kavin K. W.; Hertel, Jay; Denegar, Craig R. (December 2003). "Volume Decreases After Elevation and Intermittent Compression of Postacute Ankle Sprains Are Negated by Gravity-Dependent Positioning". Journal of Athletic Training. 38 (4): 320–324. ISSN   1938-162X. PMC   314391 . PMID   14737214.
  19. ↑ Thompson, Dakota. "Sports Medicine Monday: The Efficacy of Ice on Acute Injuries". MUSC Health. MUSC Health. Retrieved 22 March 2024.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.