Rice Method

What is RICE Method for treating Injuries?

RICE is an acronym that stands for Rest, Ice, Compression, Elevation in medical terms. Doctors recommend RICE therapy when someone has harmed his muscles, tendons, ligaments. These are referred to as soft tissue injuries.

Now let me explain to you the RICE method –

Rest

Well, there is much debate on this rest protocol from the RICE method. Nowadays, many researchers start opposing this protocol as they say rest delays healing, and excessive rest and immobilization can lead to muscle atrophy.

Once you have suffered any injury, there comes the rise of pain, as pain is the human body’s signal that something isn’t right within your body.

As it is quite natural that whenever you have suffered an injury, any person nearby will suggest you rest the injured area. Now the question arises why everyone advises you to rest?

The answer to this question is quite simple as to prevent further damage. If you continue to put weight or stress on the injured area, it will aggravate your injury (increased swelling and inflammation).

For example, someone has suffered moderate to a severe ankle sprain, or in case someone has twisted his ankle or knee, and he is continuously putting weight or pressure on the sprained ankle. It will make his injury worse. So It’s better to stop using and avoid putting weight or pressure on the injured area (sprained ankle) for at least two days.

How long should one rest?

A study was conducted on the effect of immobilization on muscle healing. Studies reveal that a short period of rest or immobilization is beneficial, but it should be limited to few days after the injury. This enables the scar tissue to link or connect the injured muscle stumps to resist further contractions generated by forces without re rupturing.

Sometimes not resting properly can lead to the risk of abnormal repair or chronic inflammation. Hence, the rest period should be long enough so that the patient can use the affected limb with the vast majority of function restored and pain essentially gone.

As Dr. Mirkin also concluded, one can use and move the injured part as long as the movement does not increase pain or discomfort. One can get back to sports activities as soon as he/she does not feel pain.

Now here the question arises how many days should one rest? A longer rest period increases muscle atrophy and muscle wasting.

The answer is quite simple: restricting the period of immobilization to a span of less than a week, the negative effects of immobilization could be minimized.

Image showing Rest in Rice method or Rice therapy

ICE

This is the most important step in the RICE method as ice therapy reduces or minimizes swelling and inflammation that causes pain.

What ice therapy does? Does ice help swelling? Does ice reduce swelling?

Ice therapy is also referred to as cryotherapy. Yes, ice therapy helps reducing swelling. It causes vasoconstriction that reduces blood flow to an injured area, significantly minimizing swelling and inflammation that causes pain.

Ice also reduces the propagation of nociceptive neural stimulation to the brain, decreasing pain and muscle spasms. ie temporarily reduces the nerve activity.

image showing ice in RICE method

Now here comes the debate nowadays many researchers claims that –

    • Icing is bad
    • cooling delays healing

Does ice delay healing? Does ice slow healing?

Dr. Gabe Mirkin in 1978 introduced the RICE method for treating soft tissue injuries sustained either from sports or any other physical activity. Now, after a lot of debate over ice delays healing, icing is bad. Dr. Mirkin composed a blog post updating his stance on the recommendation to use the R.I.C.E method to treat sports injuries.

Dr. Mirkin wrote – “Trainers have employed my “RICE” principle for a long time, but today it appears that both the complete Rest and Ice may delay healing, instead of helping.

You can read Dr. Mirkin’ss article – why ice delays healing.

Let’s talk about healing and inflammation.

Dr. Mirkin explained that when you damage your soft tissues like a fall, sudden twist, or a muscle pull, the immune system reacts by sending inflammatory cells known as macrophages to the damaged tissues.

These cells (macrophages) release a hormone known as Insulin-like growth factor (IGF-1) to the damaged cells. IGF-1 hormone helps the damaged tissue to heal, reconstruct and repair. Researches show that applying ice to the damaged area prevents the release of IGF-1, therefore, delays healing.

As we only know that ice reduces swelling and inflammation, and we also know that ice causes vasoconstriction to the blood vessels. But the dangerous side effects of vasoconstriction we don’t know. Dr. Mirkin concluded after applying ice, and the blood vessels do not open for hours. This lack of blood flow can lead to tissue death and may lead to permanent nerve damage.

So to overcome this, Dr. Mirkin recommended

In case of a recent or acute injury, you can apply ice for 10 minutes, followed by removing ice for 20 minutes and repeating this therapy once or twice on the injured area. There is no need to apply ice for 5 to 6 hours after the injury.

Ḷong back in injured athletes, ice was most often used as a short-term treatment to bring injured athletes back into the game. The cooling was used to decrease pain, but researches have shown that cooling interferes with the athlete’s strength, endurance, speed, and coordination.

Most of the researchers used cooling for more than 20 minutes, and many reported that immediately following cooling, there was a drop in athlete’s strength, endurance, speed, and coordination. And a brief re-warming interval returned the strength, endurance, speed, and coordination.

So Dr. Mirkin recommended that

In case of injured athletes, where cooling is done at all to restrict swelling and pain, it should be done for less than 5 minutes, followed by progressive warming before returning to play.

Lets us take few questions like –  Is ice bad for healing?, How long you should ice an injury?, How to properly ice an injury?

Is ice bad for healing?

No, ice is not bad for healing unless ice therapy is used properly, as in case of a recent injury, where swelling is the problem, you can apply ice up to 10 minutes on the injured area and remove it for 20 minutes. Repeat this method once or twice as applying ice reduces swelling and inflammation that causes pain. And try to limit the application of ice after two days or as soon as your swelling subsides.

What happens if you ice too long? How long should you ice an injury?

Never apply ice directly to the injured area. Wrap a towel instead before applying. Also, never apply ice for a longer period, like for 30 minutes or 1 hour, as ice causes vasoconstriction, i.e., it shuts off the blood circulation that brings the healing cells of inflammation. The decreased blood flow for a longer period may cause the tissue to die and may even cause irreversible nerve damage.

So it’s recommended to apply 10 minutes on the injured area(swelling) and remove it for 20 minutes. Repeat this method once or twice. And try to stop or limit the application of ice after two days or as soon as your swelling subsides.

Compression

In the RICE method, the word C stands for compression. Compression means wrapping the injured area with a compression or elastic bandage (like an A.C.E. bandage). This will help in decreasing swelling.

Please do not wrap the compression bandage too tightly. Otherwise, it can lead to more swelling below the injured area. It should be tight but not too tight- if it’s too tight, it will disrupt the blood flow. Signs that the bandage is too tight include numbness, tingling, increased pain, coolness, or swelling in the area below the bandage. Lose the bandage if it gets too tight.

compression in rice method

Also, remember, never use ice and compression at the same time.

How does compression reduce swelling after an injury?

Compression reduces swelling after an injury by reducing the buildup of fluid and promoting blood flow (healthy white blood cells) to the injured area.

How long should you keep the compression bandage on?

Try to wear the compression bandage only within 24 or 48 hours of the injury. Doctors suggest wearing a compression bandage up to 48 to 72 hours after the injury. Also, remove the compression bandages at night before going to sleep. If you feel you need to use the wrap for more than 48 to 72 hours, you should consult your doctor as a more serious problem.

Should I sleep with a compression bandage on?

The answer is No, remove the compression bandages at night before going to sleep. As when you are lying down, your circulatory system doesn’t have to fight gravity. Elimination of gravity can help the venous blood to return to the heart easily. Wearing a compression bandage while sleeping at night can cut your circulation off, so there is no need to wear compression bandages while sleeping.

Elevation

Elevating an injury above your heart level can help reduce swelling by increasing venous return (inflammatory exudates) of the blood to the heart. Therefore, elevation also makes it difficult for the blood to reach the injured area. Elevation also helps in reducing bleeding by lowering the pressure in the local blood vessels. 

image showing elevation of legs

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