R.I.C.E Injury Treatment – for Pain & Acute Injuries

R.I.C.E injury treatment methods include Rest, Ice, Compression and Elevation, and are known to be helpful for injuries in the first 48 hours, and for pain and swelling in general.

If you have been unlucky enough to sustain an injury – a sprain, a pulled muscle, a bad bruise, a dislocation or suspected fracture, you can always follow these basic R.I.C.E injury treatment principals in order to help your recovery. This R.I.C.E protocol is particularly useful within the first few days after an injury, as this period is what is called the “inflammatory phase” and lasts from directly after the injury happens, until around day 6. Inflammation is a normal healthy process whereby your body creates the optimal environment for tissue healing. Without inflammation healing would not take place! Swelling is part of this inflammatory process, and it is a good idea to try to control the swelling so that it is not excessive. R.I.C.E injury treatment helps to reduce excessive swelling.

Remember that if you have a clearly broken bone, severe swelling, you cannot weight bear on the limb because it is just too painful, or you hear a distinctive pop, snap or crack you should see a doctor. You also cannot apply ice to an open wound. You should also never apply ice for longer than 20 minutes, and not more than 3 times per day.

What does R.I.C.E stand for? 

• Rest 
• Ice
• Compression
• Elevation

Here is some more information about each of the above elements relating to R.I.C.E injury treatment 

Rest

Help the injured area to recover by allowing it to rest. This may mean using crutches if you are unable to walk with a normal gait due to your injury. Or to stop doing activities or sports which aggravate the painful area. The length of time you need to “rest” completely depends on the severity and nature of the injury. After the initial rest period, it becomes very important to start gently moving the injured area in order to encourage the body to lay down healthy new collagen, in addition to the movement creating a pump like action which helps to flush out swelling. 

Ice

The cold ice causes the blood vessels to constrict (or narrow) around the injured tissues. This helps to stop excessive fluid collecting around the injured tissue. Too much swelling is not helpful as it creates a lot of stiffness – especially in a joint. 

You should only ice for 20 minutes at a time though, as longer than 20 minutes causes what we call “reflexive vasodilation” which is where the blood vessels then over react causing an increase in blood flow (and swelling) to the area! 

You should also always have a thin protective layer of some sort of fabric between your skin and the ice – you do not want the ice to stick to your skin, or cause an ice burn.

Guidelines for using ice on an acute injury:

• Ice for not longer than 20 minutes at a time
• You can ice 2 – 3 times a day in the initial phase
• Make sure there is a protective layer of fabric between your injury and the ice
• Do not combine the next step (compression) with ice
• Allow your skin to return to normal temperature before you ice again
• You can use a gel ice pack, a frozen packet of peas, a tray of ice smashed up in a damp dishtowel, or even a ziplock bag filled with ice and water and wrapped in a thin towel

Compression

Compression is also useful to prevent excessive swelling in the case of an acute injury. It is important to remember that you still need to allow for normal circulation and blood flow! Here are some general guidelines for compression:  

• Do not use compression for extended periods of time
• Do not do compression for more than the first 2 – 6 days
• Ensure that sure you do not wrap it too tightly
• Do not sleep while doing compression bandaging or taping of the injury, as you do not want to wake up with a throbbing, tingling or numb limb, or worse
• Do not combine compression with ice
• If it feels too tight then take it off and re-wrap it. 

You can use elastic bandage (such as ACE bandages), or self-adherent compression bandages. 

Sometimes you may need a brace, boot, air-cast or splint which combines the effects of supporting the joint and at the same time providing compression. Your doctor or physical therapist will discuss the most appropriate options with you. 

Here are some more tips about compression: 

• Use wider elasticated bandages for larger areas. Wrap from further away towards the centre of your body
• Use narrower elastic bandaging for smaller areas such as wrists or fingers
• Self-adherent compression bandages are great as they stick to themselves, stay in place for a good length of time, and can be easily torn to the right length
• You can combine compression with elevation and rest
• Compression bandaging does not provide enough support to a joint for sporting activities, it only reduces swelling
• Do compression only in the first 2 – 6 days following an injury

Elevation              

Elevating the injury above your heart, allows gravity to give your body a healing helping hand.

• Raise the injured part of your body above you heart 
• You may need to lie down for a lower limb injury
• Use a cushion or something to support your limb
• Keep the elevated limb as straight as possible in order to allow gravity to encourage the excessive swelling to drain away from the injury.
• You can combine this element with gentle movements (for example foot pumping for a knee injury, or fist pumping for an upper limb injury) compression or with ice

A word about anti-inflammatories

Inflammation following an injury is your body’s incredibly complex and miraculous process, which is set in motion in order to heal the damaged tissues. Inflammation is important, as without it you would not get tissue healing. Anti-inflammatory medications taken in the first 48 hours potentially disrupt this important process. You can read more about it in this article. It is not ideal to take anti-inflammatories in the initial inflammatory phase following an acute injury. Pain-killers, on the other hand, work on a different pathway and are okay to take! Speak to your doctor or pharmacist to give you the best advice.

To sum up about R.I.C.E injury treatment 

Rest, Ice, Compression and Elevation help to reduce excessive swelling. 

Always consult your doctor if any of the following describe your acute injury:

• your injury is not settling
• you are unable to bear weight on the injury
• you heard a snap, crack, or pop
• you have excessive swelling or pain
• your pain is not settling

We wish you a speedy recovery. There are plenty of articles on OhMy.Health for with more information on injuries, sources of pain, rehabilitation and strengthening, and even healthy recipes for good joint health. So keep checking the website, and join up if you would like to get the most recent and useful information…

Remember to be kind to your joints!

The Joint Gurus