R.I.C.E Technique

What is the RICE Technique?

The R.I.C.E technique is the gold standard treatment of acute sporting injuries.The most important time in the treatment of acute sporting injuries is in the first 24-48 hours. When soft tissue damage occurs, for example, when a muscle tears, blood vessels rupture and the injury site begins to swell. This increase in blood volume in the area can cause cell death by what is known as secondary hypoxic injury. Thus, every effort should be made to control excessive bleeding.

The R.I.C.E technique involves all the components that are needed to prevent further injury to the damaged site immediately after the injury has been sustained. If applied correctly and in time the R.I.C.E technique can greatly reduce the recovery time of the athlete. In order to have a full understanding of the therapeutic mechanisms behind the R.I.C.E method, a knowledge of the body's intrinsic reaction to tissue damage, the inflammatory response, is needed. The letters R.I.C.E are abbreviations for:

• R-Rest
  
• I-Ice
  
• C-Compression
  
• E-Elevation

Each component functions to help limit swelling and decrease pain of the injury.

REST

Rest is the first line of action for any sporting injury. It does not only refer to a prolonged period of time following the injury but also relates to resting immediately from sporting activities. An athlete must know when to stop training -repetitive minor injuries can commonly result in a large scale injury that could have been prevented by adequate rest and treatment.

If an injury is sustained during sporting activity some athletes have a tendency to 'run it off'. This implies that with increased exercise the pain and injury will simply go away. In a lot of cases, nothing could be further from the truth. It may be possible that by continuing to exercise the athletes pain may seem less intense. This may be due to a number of factors. During exercise, nerve fibres that respond to mechanical signals such as touch can over-ride the impulses from the pain nerve fibres- a phenomenon known as the pain gate theory. In addition other factors such as the player's mentality can all play a part in over-riding the pain- however the tissue itself is still damaged and continued activity could cause serious further injury.

ICE:

Ice therapy also known as cyrotherapy is one of the most widely used treatment modalities used for acute sports injuries. It is cheap, easy to use and requires little time to prepare. The application of ice to an injury,in the acute phase can substantially decrease the extent of the damage. It achieves this in a number of different ways:

1. Decreases the amount of bleeding by vasocontriction into the injury site and so lessens swelling
2. Reduces pain
3. Reduces muscle spasm
4. Reduces the risk of cell death by decreasing the rate of metabolism

Ice is usually applied to the injured site by means of a bag filled with crushed ice which is wrapped in a damp towel. The ice should be left in place for approximately 15-20 minutes. A more detailed overview on the correct use of ice therapy and the indications for its use are available on the cyrotherapy page.

COMPRESSION:

Applying compression to a wound has the effect of preventing excessive swelling occurring and should be applied for about 24-48 hours from the onset of injury. Compression of the limb functions to increase the pressure within the tissue thus narrowing the blood vessels. This slows down the inflammatory process and so prevents excessive edema building up within the joint. This edema, when present, can severely affect the functional ability of the limb. Compression can be applied by a number of means.

• The most effective of these is by using a compression bandage which is an elasticized tube-like bandage that simply fits around the affected limb. The advantages of the compression bandage are that it is easy to apply and the elastic provides the sufficient pressure needed to stop some od the bleeding in the area.
• Alternatively a regular bandage can be applied to the area however care should be taken not to over-tighten the bandage as this will contribute to tissue death. If the peripheral limbs become discoloured or become cold then it is possible that the bandage is too tight. Bandaging should begin below the injured site with each layer overlapping the underlying layer.
• Compression can also be applied with the ice-pack itself, either manually or by wrapping the ice pack in bandage.

Elevation:

Elevation of the injured limb allows gravity to draw the fluid away from the injured site. This aids in decreasing the swelling and so can decrease pain associated with this edema. In lower limb injuries try and keep the ankle above the level of the hip. Upper limb injuries can be elevated by use of pillow or sling. The injured limb should be elevated for as long as possible throughout the day for the first 48 hours.