RICE

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Introduction

RICE is an acronym that stands for Rest, Ice, Compression and Elevation and is a way to remember the correct management in the first 24 hours following acute soft tissue injuries involving damaged blood vessels. Minimising bleeding inthis way at the injury site is important because the application of a more aggressive intervention, for example, Massage, will cause further tissue damage. When used appropriately, the RICE approach can improve recovery time and reduce discomfort.

Rest

Rest to reduce the likelihood of further damage to the tissues through increased bleeding, avoid Weightbearing or any strenuous activity involving the injured part, which will increase the time required for tissue to repair.

Ice

Ice therapy, also known as cryotherapy reduces tissue metabolism and causes blood vessel constriction. This physiological change slows and prevents further swelling - an important consideration for early active ROM exercises after the initial period of rest. Ice also decreases the proprogation of nocioceptive neural stimuli to the brain which can reduce pain and muscle spasm.

However, applying ice for an extended period of time can be detrimental to the healing process as blood flow will be reduced excessively and skin burns and nerve damage may occur. There is limited evidence surrounding dosage for cryotherapy in acute injuriy however systematic reviews suggest that 10-minute ice treatments combined with 10-minute periods without ice are most effective. It is recommended that the ice is wrapped in a damp towel or cloth to minimise the risk of superficial nerve or skin damage.

Apply caution when using cryptherapy on people who are hypersensitive to cold such as anyone with Raynaud’s syndrome, diabetes, cold urticaria, paroxysmal cold hemoglobulinuria or have a circulatory insufficiency.

Negative Effects

- Decrease in local metabolism

- Low enzymatic activity

- Less oxygen consumption 

- Reduced flexibility because cold provides stiffness and reduced elasticity of the connective tissue of the muscles

Positive effects 

- Decreases the amount of bleeding by vasoconstriction into the injury site and so lessens swelling

- Reduces pain

- Reduces muscle spasm

Apply caution when using cryptherapy on people who are hypersensitive to cold such as anyone with Raynaud’s syndrome, diabetes, cold urticaria, paroxysmal cold hemoglobulinuria or have a circulatory insufficiency.

Compression

Compression serves to prevent further Oedema (swelling) as a result of the inflammatory process and also by reducing bleeding. An elasticated bandage should be used to provide a comfortable compression force without causing pain or constricting blood vessels to the point of occlusion. Bandaging should begin distal to the injury and move proximally, overlapping each previous layer by one half. It can also serve to provide minimal protection of the injured body part from excessive movement, although this is not it's primary purpose.

Elevation

Elevation will prevent swelling by increasing venous return to the systemic circulation, and reducing hydrostatic pressure thereby reducing oedema and facilitating waste removal from the site of injury. Ensure that the lower limb is above the level of the pelvis.

Variations

• HI-RICE - Hydration, Ibuprofen, Rest, Ice, Compression, Elevation.
• PRICE, Protect, Rest, Ice, Compression, Elevation (i.e. using crutches to protect the painful part from further injury).
• PRICES - Protection, Rest, Ice, Compression, Elevation and Support (e.g. bandaging or taping).
• PRINCE - Protection, Rest, Ice, NSAIDs, Compression, and Elevation.
• RICER - Rest, Ice, Compression, Elevation, Referral.
• POLICE - Pause, Optimal Loading, Ice, Compression, Elevation.

References

• Brucker, P. & Kahn, K. (2006). Clinical Sports Medicine (third edition). McGraw Hill Australia, Pty. Ltd.
• RICE (medicine). (2008, October 21). In Wikipedia, The Free Encyclopedia. Retrieved 09:02, January 17, 2009, from http://en.wikipedia.org/w/index.php?title=RICE_(medicine)&oldid=246661676

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