RICE – The First Steps – Acute Sports Injury
Rest, ice, compression, and elevation, commonly referred to as RICE, is the first and best treatment for all your sports injuries. Believe it or not, the treatment that you undertake within the first 24 hours following an injury can literally cut weeks off of your total recovery time.
Rest is the first principle of RICE. Rest does not necessarily mean total immobilization, or weeks on crutches. However, it is important, especially within the first 24-48 hours following injury. Whether you have suffered a sprain or a strain, the actual injury involves tearing of either muscle, tendon, or ligament fibers.
Your body’s first reaction is to begin the repair process by stopping the bleeding at the site of injury. It does this by forming a clot around the injured tissues. This fibrin clot is very fragile, and rest is important to allow for both the clot formation, as well as preventing disruption of this clot after it is formed.
Once the clot is formed, your body immediately starts to repair the damaged tissue. Initially, a scar matrix is formed of very weak fibers. Good formation is generally achieved in just a few days. So following the RICE principles and resting that ankle sprain helps to protect the damaged tissue while your body starts the repair process.
There are many therapeutic properties of ice. First off, it cools the injured area, and creates a numbing type of effect. This is handy in reducing pain, and making things feel a little bit better. Ice provides pain relief by slowing down the transmission of pain signals along the nerves from the injured area to the central nervous system.
When your body is injured, there are several things that happen. First off, you get bleeding internally, from the injured ligaments, tendons, or muscles. This bleeding causes swelling in the area. As more cells move into the area to begin the repair process, the need for oxygen and nutrients at the injury site is greatly increased. However, because of the swelling in the area, the actual supply of oxygen and nutrients is greatly decreased. So you have cells that do not get enough oxygen, and end up dying. This is referred to as secondary hypoxia. One of the major benefits of ice is to limit this secondary hypoxia, or secondary tissue death.
This is achieved by reducing the need for oxygen. Ice has a cooling effect, and in turn, reduces the metabolism of the cooled tissues. This reduced metabolism decreases the need for oxygen. Cells that would normally die because of a lack of oxygen can now survive. Preventing excessive secondary tissue death is the number one reason that ice should be used immediately following an injury, and why it is an important part of RICE.
Compression is the most important part of the RICE principles. Applying some type of compressive wrap to an injured area can greatly reduce the amount of initial swelling. Swelling is a major factor in prolonged rehabilitation. Swelling will occur very rapidly, however, it takes a much longer to get rid of it. It has to be removed through the lymph system, and this is a very slow, passive process.
Compression helps to control swelling by not allowing extra fluid to pool in the spaces between the cells. Above, I told you about secondary tissue death, which is primarily caused by swelling. So it stands to reason that if you have less swelling, then you will have less secondary tissue death. I cannot stress enough how important the compression component of RICE is following an injury. For example…
Lets say we have two ankle sprains, both having the same amount of initial damage. One is left without compression, while the other is wrapped within the first hour after injury. The compressed ankle sprain will have much less overall swelling, and will most likely have a rehab time that is 1-2 weeks shorter than the sprain that wasn’t treated with compression. When you are talking about a high school season that only lasts for 10-12 weeks, 2-3 weeks more in rehab can make a huge difference. So please, don’t forget the C in RICE.
Which is more important, ice or compression? Both. A compression wrap applied underneath the ice decreases the cooling effect, and ice applied under the compression wrap reduces compression.
Elevation is the final component of the RICE principles. It simply refers to keeping the injured body part in a position higher than or equal to the level of the heart. For an ankle sprain, this would mean propping your foot up while lying down or sitting.
Elevation works on a simple premise. Gravity. Gravity pulls things down, and this is especially true with swelling. Remember, swelling is removed through the lymph system. This passive system can be greatly aided when gravity is taken out of the picture. So while you are resting to protect that newly formed clot and scar matrix, and are icing and using a compression wrap, keep that injured part elevated.