Why R.I.C.E (Rest, Ice, Compression, Elevation) isn't the go-to move anymore.
An **acute injury** is a sudden and severe injury that occurs as a result of a specific event, such as a fall, collision, or improper movement. These injuries are often associated with immediate pain, swelling, and sometimes bruising. Common examples of acute injuries include sprains, strains, fractures, and dislocations.
The acronym **RICE** stands for:
- **Rest**: Avoiding activities that might cause further injury to the affected area.
- **Ice**: Applying ice to the injured area to reduce swelling and numb the pain.
- **Compression**: Wrapping the injury with an elastic bandage to control swelling.
- **Elevation**: Keeping the injured area elevated above the heart level to reduce swelling.
While RICE is effective in managing the symptoms of an acute injury, it does not heal the injury itself. It helps control the damage and provides relief, but the underlying injury still requires proper treatment and rehabilitation to fully recover.
Think about it, if you avoid all movement altogether avoid loading range of motion and reduction of blood flow and then just return back to your previous task. It seems to reason that you may just re-injure or aggravate the area again. Let’s revisit why we should rethink the RICE principle.
Since the late 1970s, the RICE principle has been in use, but recent research has raised questions about its continued relevance. New studies suggest that inflammation is an essential component of the healing process, necessary for complete recovery (Robinson 2017).
In addition to that having long periods of inactivity, it has also been shown to delay the recovery and set you up for re-entry because it weakens the tissue and it leads to problems eventually down the road and this can turn into a cycle.
If you don’t already know this, ice causes what we call vasoconstriction which is basically when your blood vessels shrink in size and decreases the amount of healthy blood that can go in and out of that tissue. This in turn reduces your body’s ability to heal. Your body naturally releases, kinins and cytokines from damaged tissue to help bring fibrinogen and platelets for hemostasis(clotting). Other cells help to breakdown, necrotic debris(clears out the junk) and fibroblasts help increase collagen and protein to rebuild tissue.
Basically by icing and limiting movement, we are slowing down our bodies natural ability to heal. Let’s not do that.
So what should I do?
There is more and more research showing that loading and moving injured tissues as soon as you can will improve the healing process significantly. We should load the joints and tissues as much as pain allows without causing re-injury.
Avoid ice when you can to help speed up the process. Only ice in 20 minute increments for the initial 12 hours after injury if the pain is significant and helps reduce it.
Gently and routinely move the affected limb within the available range of motion.
Mild compression is okay but make sure it is done early in the day, preferably upon waking so the swelling isn’t so severe. Compressing an already swollen area hurts!
Ankle injury? ➡️ ankle ABCs, Ankle pumps, weight shifts.
Knee injury? ➡️ gentle biking, heel slides, sink squats.
Back injury? ➡️ walking, swiming, squatting without axial load (ie. without the barbell on the back). This could look like belt squats or Hatfield squats, as these options help to decrease load through the back.
Lower body fractures? ➡️do upper body. Movement (walking) in the water can also be helpful with injuries like stress fractures, as it offsets the effects of gravity and thus, decreases the amount of load through the fracture. Upper body ergometer for cardio.
Neck pain? ➡️ Movement in available range. Mid back rows!
Shoulder pain? ➡️ Isometrics and movement in a tolerable range, progressing to more range and load as pain allows.
If you or someone you care about is struggling with an acute injury and not sure how to properly rehab and return to activity, reach out and we would love to conduct a consultation with you to help you solve your problem. 502-496-6214.
Until next time,
Dr. Keyon Thompson, PT, DPT
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