RICE and sport injury management
Many of you trained in first aid might have came across the term RICE, which stands for Rest, Ice, Compression, Elevation. You might have heard it prescribed as the Gold Standard of sprain/strain management. And it does make sense in theory. Rest ensures the prevention of further injury aggravation. Ice helps with pain management and slowing the blood flow. Compression and Elevation diverts blood flow from the injured area to prevent swelling and bruising. So as it seems, RICE looks like a pretty solid formula for successful injury management right? Well, it might not be so actually.
The roots of RICE
TO fully evaluate the effectiveness of RICE, we have to first examine the roots of its development. RICE was developed in 197_ by Dr Gabriel ___. It was published in the journal of ____ and quickly became an overnight success story. However, years later, in 2014, Dr Gabriel announced that RICE was not grounded in evidence based medicine, and was simply a speculation rather than tried and tested method.
The physiology of inflammation
Inflammation is the body’s response to tissue damage, and helps to initiate and speed up the recovery process. Several things occur during inflammation. First, upon tissue damage, such as in an ankle sprain, the body reacts by initiating a blood clot, to stop any internal or external bleeding. Then, the body continues the process by dilating the blood vessels around the area and sending in white blood cells such as macrophages. Exudation occurs, where protein saturated fluid spills out from the vessels into the interstitial fluid and cause swelling. This exudated fluid will provide the nutrients essential for tissue recovery. As the inflammation process continues, the white blood cells will clear away any pathogens and produce cytokines, which are signalling molecules that will activate the immune system, eventually resulting in bruising and further swelling.
Inflammation and RICE?
The different components of RICE act in reverse of inflammation, and actually serves to inhibit the inflammation process. Rest immobilises the inured area, and prevents blood from flowing to it. Ice causes vasoconstriction of the blood vessels and prevents exudation, thus impeding swelling and protein supply to the injured tissue. Compression and elevation similarly impede the same processes. As such, RICE might not be the optimal choice of sprain management, and many health professionals are now resorting to the use of Heat and early mobilisation instead. In fact, early mobilisation of injured joints is recommended as it prevents the formation of scar tissue and laxity (looseness in the joint), and helps to reinforce the correct motor patterns early on in an injury.
So when do we use RICE?
Well, certain medical interventions are appropriate in certain situations. They key to treating or managing sports injuries is to recognise that applicability goes hand in hand with situation. Below are certain situations where RICE is recommended :
- In the middle of a sports competition, if injured party wishes to continue through the injury
- For sprains and strains only
- If ligament or muscle tear occurs and help is far away
- Not for longer than 2 hours after injury
- Use as an immediate management tool, followed by early rehabilitation fro maximal recovery.