Is it time to move on from the R.I.C.E. principle?
Anyone who has sprained an ankle or has dealt with an acute injury knows the RICE principle; rest, ice, compression, and elevation. This has been the go-to procedure follow soft tissue injuries for decades. In fact, it has been around since 1978 when Dr. Gabe Mirkin coined the term. It has since become such a foundational aspect of treating injuries that almost all healthcare providers recommend it to their patients to treat an acute musculoskeletal injury.
While the basic idea of the RICE principle is still relevant today, it is time to evolve. To this point, even Dr. Mirkin has stepped back on his support for the principle that he created over 40 years ago. While the RICE principle, at its foundation, is still helpful there are some aspects that need to be modified to be in line with today’s thinking of injury management.
In this blog we will look into the basics of the principle, what doesn’t work and what should be done to best treat an acute injury.
The Basics
The basic idea of the RICE principle is to reduce inflammation and therefore swelling and pain. The ultimate goal is to quicken the resolution of symptoms and time it takes to return to participating in athletic/recreational activities.
- Rest allows for the tissues to recover and heal and to not stress them to the point of further damage.
- Ice constricts blood flow to an area by narrowing the blood vessels and decreased nerve impulses to help with pain management.
- Compression and elevation reduces the blood flow to the area and limits the amount of swelling that can accumulate. Swelling is thought to cause pain and stiffness around a joint.
What’s Not Working
The idea that inflammation is bad and needs to be stopped might actually be more hurtful than helpful. The word ‘inflammation’ has taken on a bad rap; and this should not be the case. Acute inflammation is essential to healing. The inflammatory process increases the amount of blood flowing to the damaged area in order to bring in clean-up cells that remove damaged tissue and reduce the chance of an infection. Additionally, other cells flock to the area to help start the repair process. However, ice limits the blood that can engulf the injured area thus limiting the healing cells from helping out. Evidence to support the use of ice for acute injuries is minimal and much of the research is anecdotal. The bottom line is that without inflammation, we don’t get clean-up and repair of the damaged tissues.
The other major issue with the RICE principle is that it insinuates that rest is critical in order to heal the body. There are countless studies that have been conducted over the last number of years that have looked at early movement after injuries. Most have found that early movement is important. However, while this might not be the case for all injuries, total rest is more likely to cause more harm than good.
What Works
There have been a few different acronyms that have circulated around as a replacement for RICE. One of these is POLICE (Protection, Optimal Loading, Ice, Compression, Elevation). The ‘P’ and ‘OL’ speak to an updated theory of injury management. In many situations you will want to immediately protect the area that is injured. In the case of an ankle sprain, it may be appropriate to immediately apply a wrap or brace and to use crutches to prevent further injury to the area. Then, depending on the severity of the injury, providing optimal loading to the ankle is important for healing. This may include gradual walking and low level strengthening and balancing exercises to restore normal function.
The use of ice, compression, and elevation are still helpful when utilized in the right manner. Since ice has been proven to help reduce pain, it might be best to use it in short bursts (10 minutes) within the first few hours of an injury. In many cases, the peak of inflammation occurs only a couple hours (2-3 hours) after injury and ice might be better utilized more consistently after that point. Elevation and compression do not limit blood flow to an area as much as ice does and thus can be used more immediately after an injury.
How Can Physical Therapy Help?
Physical therapists specialize in movement limitations and are well qualified to assess soft tissue injuries and determine the best course of treatment. He or she can assess an injury to determine if you are currently appropriate to start physical therapy or should see another healthcare provider to get further assessment or imaging. Moreover, a physical therapist will help you to figure out if the use of a sling, brace, and/or crutches are best for you. Most importantly, a therapist will work with you to find the best time to stop protecting the injury and start using the body part again. A physical therapist will also be able to show you exercises that will help you regain your motion, strength, balance, and function so you can return to your activities.
While these principles can be applied to most injuries, it is critical to seek out professional assessment to determine if there is an emergency medical situation and to rule out a broken bone, infection, and to determine if movement will worsen your condition.