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RICE: The How and Why
May 20, 2017
Winter sports' seasons are well under way, and with them we physios start to see many more sprain and strain injuries.
Despite acute injury management posters being up on the walls in many sporting clubs, and most people having heard that you "RICE" an injury, there are still plenty of people who don't seem to be a full bottle and how to acutely manage their sprain or strain.
What is "acute injury management"?
When you suffer an injury like a sprained ligament or a muscle strain your body begins a process to heal this injury straight away. The first part of the healing process is the acute phase, which generally lasts around 3-5 days. In the acute phase chemicals in the blood trigger an increase in inflammation at the injury site. Inflammation contains the things the body uses to heal the injury, and also contains the chemicals that make you feel pain (this is a good thing, believe it or not, as the pain lets you know you're injured so that you're more likely to put less stress over the injury site and allow it to heal.
Inflammation also contains chemicals that over time can degrade tissues and cause stiffness. For this reason, and to reduce pain, during the acute phase we want to do things to limit and control the inflammation. This is "acute injury management".
What does RICE stand for?
In a bit more detail?
Rest - More accurately "relative rest". We're not talking laying on the couch for three days straight catching up on Netflix. The body is designed to keep moving and complete bed rest negatively impacts our health. Small bouts of walking and standing (with or without crutches as your pain requires) will actually help stimulate better healing of lower limb injuries and reduce the build up of inflammation. Just avoid activities that will put too much load through the injured area (eg running, jumping, walking for several hours etc).
Ice - Apply ice in the form of an ice pack over the affected area for about 10-15 minutes at a time every couple of hours. Using ice in this way will slow the inflammatory process, and also reduces pain through a numbing effect.
Compress - The use of compression stockings like tubigrip, compression taping or compression garments assists the drainage of the inflammatory fluid. The lymphatic vessels are responsible for clearing excess fluid. These vessels have valves to prevent the backflow of fluid, but they have no ability to actively move fluid through themselves. They rely on muscles contracting around them to move fluid through them, and compression helps make this process more efficient.
Elevate - Elevating the injured area above the level of the heart when it is convenient to do so will allow gravity to assists your lymphatic vessels to drain inflammation. You only need to place it slightly above the heart, for example lying on your back and placing a sprained ankle on top of two pillows.
What else can I do?
You may have heard the acronym HARM as being things to avoid with an acute injury. This stands for Heat (heat packs will increase inflammation), alcohol (alcohol increases inflammation), running (because it's the opposite of rest), and massage (gentle, non-painful massage is ok, firmer massage will increase inflammation). Avoiding these things in the acute phase will reduce your pain and inflammation.
Anti-inflammatory medications can help reduce inflammation, but as they're medications it's best to discuss the use of these with a doctor or pharmacist as there are potential side effects and drug interactions of which you may need to be aware.
Physiotherapists add a few letters to RICE to become SPRICEMMM (a less catchy acronym, sure) to include other treatments which will help reduce pain and inflammation and protect the injured tissue. Such treatments might include hands-on treatments, taping and bracing, or the use of machines such as ultrasound. With a sprain or strain type injury it's best to get it seen to by a physiotherapist to get a diagnosis, get optimal acute injury management and to formulate a plan for safe return to sport.