RICE - The First Steps
Rest, ice, compression, and elevation, commonly reffered to as RICE, is
the first and best treatment for all your sports injuries.
it or not, the treatment that you undertake within the first 24 hours
following an injury can literally cut weeks off of your total recovery
No one wants to suffer from a sports injury, but more than likely, at
some point they are bound to happen. Following the RICE principles will
speed your recovery, and get you back into the game faster. And that is
the ultimate goal with sports injuries. To fully understand why RICE
works, lets look a bit closer at each of the different elements.
Rest is the first principle of RICE. Rest does not necessarily mean
total immobilization, or weeks on crutches. However, it is important,
especially within the first 24-48 hours following injury. Whether you
have suffered a sprain or a strain, the actual injury involves tearing
of either muscle, tendon, or ligament fibers.
Your body's first reaction is to begin the repair process by stopping
the bleeding at the site of injury. It does this by forming a clot
around the injured tissues. This fibrin clot is very fragile, and rest
is important to allow for both the clot formation, as well as
preventing disruption of this clot after it is formed.
Once the clot is formed, your body immediately starts to repair the
damaged tissue. Initially, a scar matrix is formed of very weak fibers.
Good formation is generally achieved in just a few days. So following
the RICE principles and resting that ankle sprain helps to protect the
damaged tissue while your body starts the repair process.
There are many therapeutic properties of ice. First off, it cools the
injured area, and creates a numbing type of effect. This is handy in
reducing pain, and making things feel a little bit better. Ice provides
pain relief by slowing down the transmission of pain signals along the
nerves from the injured area to the central nervous system.
pain relief is beneficial following injury, the most important
function of ice has more to do with its effects on the actual cells in
the injured area. This can get a bit complicated, so stay with me...
your body is injured, there are
that happen. First off, you get bleeding internally, from the injured
ligaments, tendons, or muscles. This bleeding causes
in the area. As more cells move into the area to begin the repair
process, the need for oxygen and nutrients at the
injury site is greatly increased. However, because of the swelling in
the area, the actual supply of oxygen and nutrients
is greatly decreased. So you have cells that do not get enough oxygen,
and end up dying. This is referred to as secondary hypoxia.
One of the major benefits of ice is to limit this secondary hypoxia, or
secondary tissue death.
This is achieved by reducing the need for oxygen. Ice has a cooling
effect, and in turn, reduces the metabolism of the cooled tissues. This
reduced metabolism decreases the need for oxygen. Cells that would
normally die because of a lack of oxygen can now survive. Preventing
excessive secondary tissue death is the number one reason that ice
should be used immediately following an injury, and why it is an
important part of RICE.How to use ice
Compression is the most important
part of the RICE
principles. Applying some type of compressive wrap to an injured area
can greatly reduce the amount of initial swelling. Swelling is a major
factor in prolonged rehabilitation. Swelling will occur very rapidly,
however, it takes a much longer to get rid of it. It has to be removed
through the lymph system, and this is a very slow, passive process.
Compression helps to control swelling by not allowing extra fluid to
pool in the spaces between the cells. Above, I told you about secondary
tissue death, which is primarily caused by swelling. So it stands to
reason that if you have less swelling, then you will have less
secondary tissue death. I cannot stress enough how important the
compression component of RICE is following an injury. For example...
Lets say we have two ankle sprains, both having the
same amount of initial damage. One is left without compression, while
the other is wrapped within the first hour after injury. The compressed
ankle sprain will have much less overall swelling, and will most likely
have a rehab time that is 1-2 weeks shorter than the sprain that wasn't
treated with compression. When you are talking about a high school
season that only lasts for 10-12 weeks, 2-3 weeks more in rehab can
make a huge difference. So please, don't forget the C in RICE.
patients often ask which is more important, ice or compression. And I
reply - both. However, sometimes it is hard to get both at the same
A compression wrap applied underneath the
ice decreases the
cooling effect, and ice applied under the compression wrap reduces
There is an answer though, and one
that I highly
recommend. It is a ice compression wrap. Comprised of a cold gel pack
encased in a fabric wrap, it allows you to ice and compress a body
part, and is the perfect way to apply the R.I.C.E. principles.
Every single ACL reconstruction patient that I see at the clinic is
given an ice compression wrap - and these run around $160.00. Not
cheap...however it works wonders on sore muscles and acute
Elevation is the final component of the RICE principles. It simply
refers to keeping the injured body part in a position higher than or
equal to the level of the heart. For an ankle sprain, this would mean
propping your foot up while lying down or sitting.
Elevation works on a simple premise. Gravity. Gravity pulls things
down, and this is especially true with swelling. Remember, swelling is
removed through the lymph system. This passive system can be greatly
aided when gravity is taken out of the picture. So while you are
resting to protect that newly formed clot and scar matrix, and are
icing and using a compression wrap, keep that injured part elevated.
What about heat?
If you have noticed, all of the RICE principles are primarily used to
help control swelling
. In the world of sports
injuries, swelling is the
biggest obstacle for recovery. Swelling causes pain, because it
increases the pressure in the area, specifically the pressure on nerve
endings. It restricts range of motion. And swelling even decreases
strength by causing muscles to shut down. As swelling decreases, pain
levels decrease, range of motion increases, and muscular strength
improves. RICE addresses swelling in the best ways possible.
The reason you apply heat to an area is to increase
blood flow. This is not a good idea in an acute injury. Increased blood
flow causes more fluid to move into an area, which can result in more
This is completely opposite of the RICE principles. Strike
Increased temperatures cause an increase in
metabolism, and an increased need for oxygen. Remember, the tissues
surrounding an injury are already starved for oxygen, and so applying
heat can cause more secondary tissue death. Again, not in line with
RICE. Strike two.
While applying heat to an injured area will no
doubt feel much better than applying ice, using heat too soon following
injury can increase rehabilitation times, and prolong your return to
play. Strike three.
Four Letters to Live
Ask any physician, certified athletic trainer, or other sports medicine
professional and they will all tell you the same. RICE is the
best thing you can do immediately following an injury
. So the
next time you twist that ankle during a basketball game, follow the
RICE principles immediately, and start your recovery out on the right
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