Rice

What is RICE?

RICE is an abbreviation for:

• Rest
• Ice application
• Compression, and
• Elevation

It is the protocol applied for early management of a soft tissue injury involving muscles, tendons or ligaments.

When the body is injured, the trauma initiates an inflammatory response in the area. Inflammation is the body’s protective response against the injury. The signs of inflammation include pain, swelling, redness and impairment of function. These signs inform the body (through pain signals) that the area is injured and that it should rest (swelling and impairment of function). However, these natural processes slow down the recovery.

The aim of the RICE protocol is to speed up the healing process. It serves to reduce pain and swelling in the area, which allows the person to move the injured limb with relative ease. This early mobility helps to improve the circulation in the area, which further speeds up healing by supplying more nutrients to the area. Moreover, limiting inflammation decreases the risk of excessive scar formation that may impair the functioning of the tissue.

When to apply RICE?

Simple sprains and strains are best treated using the RICE protocol. A sprain refers to a stretching or tearing injury of the ligaments, which are tough fibrous bands and serve to attach and hold the bones together in a joint. On the other hand, a strain involves stretching or tearing of muscles or their fibrous extensions called tendons that attach the muscles to the bones.

Sprains and strains are common sports injuries, but one may also acquire them while performing routine activities.

The RICE protocol needs to be applied immediately after an injury. It produces best results when used within 24 to 48 hours of injury; however, it may work up to 72 hours post injury (a late application is not as effective as if it is applied earlier).

How to apply RICE?

Rest:

This simply means giving the injured part some time off and avoiding any activity that induces pain in the injured area or disturbs it in any way. If you have suffered an ankle sprain, rest means no walking (unless with crutches) and no weight or pressure on the affected ankle. This goes for the rest of the injuries as well.

The best strategy is to stop any painful activities and rest until you are pain free. A couple of days rest is usually all that is needed, then it is better to start moving your limb. Prolonged rest can jam your joints, stiffen your ligaments and weaken your muscles.

Once you are pain free start exercising, but be patient, you cannot re-start from where you left off before the injury. You need to work up to the previous activity level gradually; avoid any painful movements and take care not to overdo any movements.

Ice:

Ice application should start immediately after the injury; it serves two purpose:

1. It constricts the blood vessels in the area thereby:
   

   decreasing any bleeding (if occurring) and

   decreasing the influx of fluid into the area (a part of inflammation); this prevents swelling

2. Moreover, it numbs the nerve endings in the area, helping to decrease pain.

You can either leave the ice pack in place for a while or use it to massage the area gently.

The application time varies with the site and extent of injury. Ice should be applied from 10 to 30 minutes at a time. Care should be taken when applying ice at the joints such as at the ankle or knee, as these are devoid of any insulating soft tissue and are only covered with skin, so the application time should be kept at a minimum.

What can you use as ICE?

A commercial cold pack is good if you have one (commercial cold packs are often colder than ice, so the application time should be adjusted accordingly). Alternatively, you can use crushed ice in a plastic bag or a bag of frozen peas, or anything else that will mould easily to the surface to which it is applied. Or you can freeze a paper cup filled with water and then remove its base, exposing the ice. Use this cone to perform an ice massage over the area that is painful.

However, certain points need to kept in mind in this regard:

Do not apply ice directly to the skin for it may burn the skin – cover the skin with a towel or a bandage or keep the ice moving. Do not let the ice pack rest on bare skin and never go to sleep leaving an ice pack over your limb.

Apply ice for about 20 minutes at a time or until the area starts feeling numb. Then remove the ice pack and give the skin some time (at least 40 minutes to an hour) to recover.

Before reapplying it is better to touch the skin, if you can feel the touch and the skin also feels warm, you can apply the ice again

Do not apply ice on damaged skin (cuts and sores)

People with a blood circulation problem should avoid using ice

Ice can be applied several times a day; however, the therapy works best within the first three days following the injury.

Compression:

Compression is yet another way to reduce swelling at the site of injury. Compression assists ice application and serves to:

reduce swelling or any bleeding in the area by compressing the vessels.

provide a little support to the injured area and may aid in reducing the pain.

The injured site can be compressed using an elastic bandage or athletic tape. Start wrapping the bandage from the outer side towards the heart, i.e. from the toes upwards. This prevents blockage of blood flow.

A bandage wrapped too tightly may also constrict the blood flow. If you feel a numb or tingling sensation, or the area under the bandage starts feeling cold or turns blue, it means the bandage is too tight. Remove and re-wrap it.

You can also use a compression sleeve that covers the whole joint and the surrounding area. The bandage or sleeve also acts as a barrier during ice application, protecting the underlying area from ice burns.

Elevation:

This means elevating the injured limb, but not just from the ground, it should be elevated above the heart level. This serves to:

slow down the blood flow to the area.

promote the drainage of blood and fluid from the site, as the pull of gravity will work for and not against it.

This reduces any bleeding or swelling in the area.

Keep the limb elevated as much as you can. Like other factors, it also works best in the initial stages after injury.

One must keep in mind that RICE is the immediate and not the ultimate treatment. It is only effective within the first two or three days after the injury. A prolonged RICE regime may actually reverse the healing progress, especially in the case of ligament and tendon injuries (sprains or strains), as such injuries heal better when exercise and physiotherapy is started early in the treatment.