The RICE Therapy Approach
What is R.I.C.E.?
R.I.C.E. is an acronym (a word coined from first letters) for the most important elements – rest, ice, compression and elevation – in first aid for many injuries. This acronym appears frequently in literature related to injury prevention and rehabilitation related to athletic injuries. The word R.I.C.E. is used to jog the memory when athletic trainers are faced with such injuries as contusions, sprains, strains, dislocations or uncomplicated fractures.
Stop using the injured part, and rest it as soon as you realize an injury has taken place. Continued exercise or other activity could cause further, more extensive injury, delay healing, increase pain and stimulate bleeding. Use crutches to avoid bearing weight on injuries of the foot, ankle, knee or leg. Use splints for injuries of the hand, wrist, elbow or arm. After medical treatment, the injured part may require immobilization with splints or a cast to keep the area at rest until it heals.
Ice helps stop internal bleeding from injured blood vessels and capillaries. Sudden cold causes small blood vessels to contract. This contraction of blood vessels decreases the amount of blood that can collect around the wound/injury site. The more blood that collects, the longer the healing time. Ice can be safely applied in several ways using the following instructions.
For injury to a small area, such as a finger, toe, foot or wrist, immerse the injured area in a bucket of ice water. Use ice cubes to keep the water cold, as ice dissolves.
- For injury to a larger area, use ice packs. Avoid placing ice directly on the skin. Before applying the ice, place a towel, cloth, or one or two layers of an elasticized compression bandage(Ace bandage) on the skin to be iced. To make the ice pack, put ice chips or ice cubes in a plastic bag, or wrap them in a thin towel. Place the ice pack over the cloth. The pack may sit directly on the injured part, or it may be wrapped in place.
- Ice the injured area for about 30 minutes (no matter what form of ice treatment you are using).
- Remove the ice to allow the skin to warm for 15 minutes.
- Reapply the ice.
- Repeat the icing and warming cycles for 3 hours while following the instructions below for compression and elevation. If pain and swelling persist after 3 hours, consult your doctor (If you have not already done so). Your doctor may change the icing schedule after the first 3 hours. Regular ice treatment is often discontinued after 72 hours. At that point, heat is often more comfortable. Or you might try contrast baths of injured area-alternating 5 minutes of hot water with 5 minutes of ice water.
Compression decreases swelling by slowing bleeding and limiting the accumulation of blood and plasma near the injury site. Without compression, fluid from adjacent normal tissues seeps into the injury area. The more blood and fluid that accumulate around an injury, the slower the healing. Here are some instructions for safely applying compression to an injury.
- Use an elasticized bandage( Ace bandage) for compression, if possible. If you do not have one available, any kind of cloth will suffice for a short time. Wrap the injured part firmly, wrapping over the ice also. Begin wrapping below the injury site and extend above the injury site.
- Be careful not to compress the area so tightly that the blood supply is impaired. Signs of blood supply deprivation include pain, numbness, cramping and blue or dusky-colored nails. Remove the compression bandage immediately if any of these symptoms appears. Leave the bandage off until all signs of impaired circulation disappear. Then rewrap the area-less tightly this time.
Elevating the injured part above the level of the heart is another way to decrease swelling and pain at the injury site. Elevate the iced, compressed area in whatever way is most convenient. Prop an injured leg on solid objects or pillows. Elevate an injured arm by lying down and placing pillows under the arm or placing them on the chest with the arm folded across. The whole upper part of the body may be elevated gently with pillows or a reclining chair or by raising the head of the bed on blocks.