RICE is a mnemonic for four elements of treatment for soft tissue injuries – an acronym for Rest, Ice, Compression and Elevation. The mnemonic was introduced by Gabe Mirkin in Sportsmedicine Book (ISBN 978-0316574365) in year 1978. However, he has since recanted his support for the regimen. On March 16, 2014, he wrote "Coaches have used my 'RICE' guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping. In a recent study, athletes were told to exercise so intensely that they developed severe muscle damage that caused extensive muscle soreness. Although cooling delayed swelling, it did not hasten recovery from this muscle damage."
Contents
RICE is considered a first-aid treatment, rather than a cure for soft tissue injuries. The aim is to manage discomfort and internal bleeding.
Evidence
There is not enough evidence from randomized controlled trials to determine the true effectiveness of RICE therapy for acute ankle sprains. Treatment decisions for ankle sprains must be made on an individual basis and relies on expert opinions and national guidelines.
Rest
Rest is a key component of repairing the body. Without rest, continual strain is placed on the affected area that is injured, leading to increased inflammation, pain, and possible further injury. Rest is recommended during the initial 24–48 hours after an injury, but after that modified activities can be started. Additionally, some soft tissue injuries will take longer to heal without rest. There is also a risk of abnormal repair or chronic inflammation resulting from a failure to rest. In general, the period of rest should be long enough that the patient is able to use the affected limb with the majority of function restored and pain essentially gone.
Ice
Ice is excellent at reducing the inflammatory response and pain associated with heat generated by increased blood flow and/or blood loss. A good method is apply ice for 20 minutes of each hour. Other recommendations are an alternation of ice and no-ice for 15–20 minutes each, for a 48-hour period. To prevent localised ischemia or frostbite to the skin, it is recommended that the ice be placed within a towel or other insulating material before wrapping around the area.
Exceeding the recommended time for ice application may be detrimental, as it has been shown to delay healing.
Compression
Compression aims to reduce the edematous swelling that results from the inflammatory process. Although some swelling is inevitable, too much swelling results in significant loss of function, excessive pain and eventual slowing of blood flow through vessel restriction.
An elastic bandage, rather than a firm plastic bandage (such as zinc-oxide tape) is required. Usage of a tight, non-elastic bandage will result in reduction of adequate blood flow, potentially causing ischemia. The fit should be snug so as to not move freely, but still allow expansion for when muscles contract and fill with blood.
Compression stockings or sleeves are a viable option to manage swelling of extremities with graduated compression (where the amount of compression decreases as the distance to the heart decreases). These garments are especially effective post-operatively and are used in virtually all hospitals to manage acute or chronic swelling, such as congestive heart failure.
Elevation
Elevation aims to reduce swelling by increasing venous return of blood to the systemic circulation. This will result in less edema which reduces pain and/or swelling.
Variations
Variations of the acronym are sometimes used, to emphasize additional steps that should be taken. These include:
Alternatives
As RICE and its variations work by reducing blood flow to the injured area, some people argue that for certain types of injuries (such as damage to ligaments and tendons) a protocol that increases blood flow, such as MEAT (Movement, Exercise, Analgesics and Treatments), should be used instead.