RICE (medicine)

Rest is a key component of repairing the body. Without rest, continual strain is placed on the affected area, 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.[9] 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.

In 2015, Gabe Mirkin, the doctor who initially coined the term R.I.C.E in his 1978 book "The sports medicine book", has eliminated his recommendation for ice except within the first six hours since injury to reduce pain, as it has since been shown to reduce healing. The inflammation is reduced due to a decrease in leukocytes and granulocytes and the restriction of macrophage infiltration. These physiological changes can slow down the healing process. Typically, when the body detects an injury, it sends a message to the inflammatory cells (macrophages) to produce growth factor (IGF-1). This kills the damaged tissue, resulting in healing. However, ice causes vasoconstriction when applied. This prevents the transport of inflammatory cells and chemicals. If IGF-1 cannot get to the site of injury, the healing process can be delayed, or even inhibited[10][11].[12][13]

Even more, studies have found a significant decrease in one's capability to reproduce knee joint flexion in the sagittal plane and causes a lack of varus control leading to a valgus shift in the frontal plane during eccentric contraction after the use of cryotherapy.[14]

There is no definitive evidence that ice is effective or ineffective. But evidence does show that ice can be used as an adjunct to therapeutic rehabilitation in that ice helps reduce localized pain.[15] A combination of cryotherapy followed by exercise saw the best result in strength gain.[16] Exceeding the recommended time for ice application may be detrimental, as it has been shown to delay healing.

Ice reduces the inflammatory response and pain associated with heat generated by increased blood flow and/or blood loss.[17] 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 period of 48 to 72 hours, and then apply heat if swelling is gone. It is recommended that the ice or heat pack be placed within a towel or other insulating material before wrapping around the area.[18]

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. 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 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.

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.