[The Physician and Sportsmedicine]

[REHAB ADVISER]

Using RICE for Injury Relief

Thomas D. Rizzo, Jr, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 10 - OCTOBER 96

Few athletes, whether serious or casual, completely avoid injuries to soft body tissues like muscles (strains) or ligaments (sprains). Though painful, minor sprains or strains often don't require a trip to the doctor's office. What, then, is a mildly injured body to do to get on the right track to healing?

The "RICE" method can help you control pain and swelling and minimize the side effects of an injury. RICE stands for rest, ice, compression, and elevation. Severe or persistent pain or swelling or a decline in your performance usually mean it's time to seek medical help.

RICE Is Nice

When tissue is damaged, fluid accumulates in the injured area, leading to swelling. Swelling will limit the motion of the joint and may contribute to pain if it gets bad enough. RICE therapy is important because swelling in an extremity is hard to reverse once it's been there awhile. It's best to prevent it in the first place.

Rest is essential to keep an injury from getting worse. If you ignore the problem, you may continue to aggravate the tissue damage.

This doesn't mean you have to stop completely. You can try "relative rest," which means continuing an activity if pain allows, or switching to an activity that doesn't cause pain--like swimming for an ankle sprain. If the activity hurts, don't do it. If it doesn't hurt, continue. It may mean you can do only part of an activity--ground strokes in tennis but not serves, for example--but this might be better than stopping completely.

Ice or anything cold can effectively decrease pain from an injury. Icing deadens pain and beneficially changes blood circulation: It increases circulation to the skin but decreases it in deeper tissues where bleeding may be occurring. An ice pack can be used on the injured part as soon as possible and kept there for 20 minutes. Place a thin sheet, napkin, or layer of mineral oil between the skin and the pack to protect the skin surface.

Smaller areas can be treated with ice massage. Water frozen in a paper cup can be rubbed on the injury for 5 to 10 minutes (peel back the top of the cup to expose the ice).

If the skin turns white or blue during icing or ice massage, stop immediately. Cold treatments can be repeated every 2 hours. There is no advantage to using ice packs or massage longer or more often. And greater exposure to the cold increases the risk of frostbite.

Compression of the injured area also can prevent fluid from accumulating. An elastic wrap or stocking can be very effective. It should be applied firmly, but not tightly, right away. (You can ice right through a thin wrap.) If the part of the arm or leg that is farthest from the heart throbs, the wrap is too tight and needs to be loosened. Reapply compression wraps every 4 hours.

Compression will help if the swelling is from bleeding, and it may also decrease pain. The reason for this is not well understood, but many people feel better with something tight (but not too tight) on an injured wrist or ankle.

Elevation of the affected extremity limits swelling by using gravity to help drain fluid from the injured tissue. Of course, this advice is more practical for ankles and hands than backs and hips. Whenever you rest, elevate your injured arm or leg.

Getting Back in Shape

Using the RICE method for pain control may allow you to work gradually back into your exercise regimen without taking a lot of time off and without a formal rehabilitation program (see "What About Heat?" below). But remember: You are not healed just because the injury doesn't hurt anymore. You still have to regain motion and strength. Until this happens, you are more likely to get reinjured.

What About Heat?

Heat, like ice, can deaden pain, and many people will attest that it feels good. The problem is that it can also promote swelling--something you want to avoid after an injury. Also, heat may increase deep circulation, which can be devastating if bleeding is involved.

Once the injury is under control, however, and your greatest discomfort is associated with stiffness, heat can help. Usually this means at least 2 or 3 days after the injury occurred. You can use hot packs or a hot bath or whirlpool to help loosen up the joint before activity. But beware: If any swelling develops, stay away from the heat.

Remember: This information is not intended as a substitute for medical treatment. If you have persistent pain or swelling or have another medical concern, consult a physician.

Dr Rizzo is a consultant in physical medicine and rehabilitation at Mayo Clinic Jacksonville in Jacksonville, Florida. He is also an editorial board member of The Physician and Sportsmedicine.


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