- Rest, Ice, Compression, and Elevation (RICE)
- Topic Overview
- Treating Sprains and Strains: Are You Doing It Wrong?
- Past Treatments Based on Guesswork
- The Value of Early Exercise
- Treating a Sprain
- Clarifying the R.I.C.E. Method for Minor Injuries
- R.I.C.E. for a Sprained Ankle?
- R.I.C.E. Treatment: Rest, Ice, Compression, Elevation
- RICE Treatment
- Rest, Ice, Elevation, Compression and …
- Comparing RICE and MICE
- Ice, compression and elevation
- When should you see a doctor?
Rest, Ice, Compression, and Elevation (RICE)
As soon as possible after an injury, such as a knee or ankle sprain, you can relieve pain and swelling and promote healing and flexibility with RICE—Rest, Ice, Compression, and Elevation.
- Rest. Rest and protect the injured or sore area. Stop, change, or take a break from any activity that may be causing your pain or soreness.
- Ice. Cold will reduce pain and swelling. Apply an ice or cold pack right away to prevent or minimize swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. After 48 to 72 hours, if swelling is gone, apply heat to the area that hurts. Do not apply ice or heat directly to the skin. Place a towel over the cold or heat pack before applying it to the skin.
- Compression. Compression, or wrapping the injured or sore area with an elastic bandage (such as an Ace wrap), will help decrease swelling. Don’t wrap it too tightly, because this can cause more swelling below the affected area. Loosen the bandage if it gets too tight. Signs that the bandage is too tight include numbness, tingling, increased pain, coolness, or swelling in the area below the bandage. Talk to your doctor if you think you need to use a wrap for longer than 48 to 72 hours; a more serious problem may be present.
- Elevation. Elevate the injured or sore area on pillows while applying ice and anytime you are sitting or lying down. Try to keep the area at or above the level of your heart to help minimize swelling.
Nonsteroidal anti-inflammatory drugs (NSAIDs) may also help relieve your pain and swelling. They include:
- Ibuprofen, such as Advil or Motrin.
- Naproxen, such as Aleve or Naprosyn.
Be safe with medicines. Read and follow all instructions on the label.
When your soreness and pain are gone, begin stretching and strengthening exercises slowly, then gradually increase these exercises.
Treating Sprains and Strains: Are You Doing It Wrong?
If you search online for advice about sprains and strains, you’ll find the traditional prescription — rest, ice, compression, and elevation (RICE) repeated over and over. But now some researchers think it needs updating — especially the “rest” part.
“This RICE construct doesn’t necessarily reflect modern science,” according to Eric Robertson, a spokesman for the American Physical Therapy Association. He says the same goes for the PRICE variation where “P” stands for “protection.”
Too often patients and even doctors treat sprains by immobilizing their joints in casts, slings, and “walking boots,” says Robertson. But immobility reduces circulation and can cause muscles, nerves, ligaments, and tendons to weaken from disuse. Instead, Robertson counsels patients to work with healthcare providers to find exercises that will speed healing.
Related News: New Study Fuels Controversy Over Football Concussions in Teens “
Past Treatments Based on Guesswork
Even without medical attention, sprains and strains usually improve over time. But in the United States alone, some 28,000 ankle injuries occur every day. And the damage can linger. One study showed that only 35 to 85 percent of sprained ankles heal completely within three years.
So researchers have been questioning the way these injuries are treated. They’ve found that the RICE advice came about more from educated guesswork than actual research.
What happens when you actually put these ideas to the test? As far back as 1994, doctors at Oregon Health & Science University randomly divided 82 patients with sprained ankles into two groups. One group wore an elastic wrap for two days, and then switched to braces that allowed for movement. They exercised their ankles under the supervision of the physicians, gradually putting more weight on the injured joint.
The other group wore plaster splints for 10 days, preventing motion in their ankles. Then they started the same exercise and weight-bearing program.
Ten days after their injuries, 57 percent of the early mobilization group had fully returned to work, compared with only 13 percent of the plaster splint group. Three weeks after their injuries, 57 percent of the early mobilization group still experienced pain, compared with 87 percent of the plaster splint group.
It’s Science: How Yoga Improves Overall Athletic Performance “
The Value of Early Exercise
Similar studies have since confirmed the value of early exercise for all but the most severe sprains. They have also shown benefits for balance training — for example, standing on the injured foot with your eyes closed — which improves the function of nerves in the joint and can increases stability.
Citing evidence like this, a 2012 editorial in the British Journal of Sports Medicine suggested replacing RICE and PRICE with POLICE — protection, optimal loading, ice, compression and elevation.
But the “ICE” part of the treatment also remains poorly tested. In some trials, patients who received cold treatments did better than those who did not. In others, there was no difference.
“We do know it’s a good pain reliever,” says Thomas Kaminski, who helped devise the National Athletic Trainers’ Association’s official guidelines on ankle sprains, published last year. Most experts continue to recommend some kind of cold treatment, with the reasoning that people can start moving their sprained joints more quickly if they hurt less.
(To avoid frost bite, they caution against icing for more than 20 minutes at a stretch, however, and recommend using some sort of insulation like a wet towel, especially when applying chemical cold packs that get below freezing temperature.)
The same problem applies to compression and elevation. Tightly wrapping a sprained wrist or ankle reduces swelling. A less swollen joint is easier to move, and theoretically the pressure can reduce internal bleeding. But hardly anyone has actually compared healing in patients who receive this sort of compression with those who don’t.
Fewer studies still have examined the effects of elevation. Putting your foot up might reduce swelling in your ankle, one team of researchers concluded, but the swelling comes right back when you stand up again.
Find Out: What Do Smart Fabrics Mean for the Future of Health? “
Treating a Sprain
So what else can you do about a sprain? Heat treatments might do more harm than good, Kaminski’s team concluded. Electrical stimulation, an experimental treatment some clinics offer, has gotten mixed results.
Drugs can temper the pain. But all have potential side effects. And some of them, non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen, could theoretically interfere with the healing. Kaminski recommends using acetaminophen if you need a pain killer for the first 48 hours, with use of NSAIDs safe after that.
With so few other options — and little risk — most experts are advising patients and doctors to stick with ICE until further notice.
“I think nobody would make the argument that if you get a musculoskeletal injury you should just let it swell,” says Stephen Rice, a pediatric sports medicine doctor and former chair of the Health and Science Policy Committee for the American College of Sports Medicine. ” don’t have the hard science, but I have nearly 40 years of experience that if you can control the swelling people can return faster.”
Barbara Bergin, a fellow with the American Academy of Orthopedic Surgeons agrees. “You just can’t beat rest, ice, compression and elevation,” she says.
But she adds that you should only follow this prescription until you are able to consult with the appropriate healthcare provider, for example when “you sprain your ankle and it’s a Sunday afternoon and you don’t want to have to go to the emergency room you’ll have to wait in line for hours, and you’ll have to pay a lot, and your doctor will be in on Monday.”
Even critics of the RICE formula are willing to go along with that, for now. “RICE by itself is not necessarily too dangerous,” says Robertson. “But you should know that there is a better way.”
Learn All About Gym Etiquette — Do You Know the Rules? “
Clarifying the R.I.C.E. Method for Minor Injuries
When should you implement the R.I.C.E. method after a soft-tissue injury? RICE stands for rest, ice, compression, and elevation.
Most mild injuries, such as knee or ankle sprains or strained muscles, heal with RICE. Moderate sprains may also require a period of bracing or wearing splints. RICE is a simple way of reducing swelling, easing pain, and speeding up recovery.
If you have pain or swelling that gets worse, or doesn’t heal after using the RICE method, see a doctor. For those who exercise regularly, such as runners or cyclists, or those who take part in sports activities, stretching beforehand is a good way of preventing soft-tissue injuries.
“Especially as we get older, you have to take the some time to stretch,” says Derek Papp, M.D., sports medicine physician with Miami Orthopedics & Sports Medicine Institute. “You don’t have to necessarily do it before you go out. But do a light warm-up exercise — a light jog or short walk before you start running. Then do your stretching, and that helps avoid injuries.”
Here’s a rundown of R.I.C.E., with helpful tips for each of the four steps.
1: Rest: As soon as you’re hurt, stop doing the activity that brought on the pain and rest as much as possible, at least 48 hours. But don’t rest for too long. While resuming activities too soon can aggravate strains or sprains, too much rest can present issues such as stiffness or lack of proper circulation. Says Dr. Papp: “I tell my patients that have back pain to rest and take some days off, but you don’t want them to stay in bed for a week because that’s not helpful and you can get stiff.”
2. Ice: For reducing pain and swelling, ice always helps especially within 24 hours after the injury. Apply an ice pack (covered with a light, absorbent towel to help prevent burns to the skin) for at least 10 minutes. Repeat this as often as possible for the first 24 to 48 hours after your injury. “Ice can help with initial inflammation from the injury,” says Philip Depaola, physician’s assistant with Miami Orthopedics & Sports Medicine Institute. “Afterward, in a recovery setting, ice can help in calming down inflammation from any type of rehab procedure or physical therapy. But mainly it can help with that initial blood flow to the area that can cause swelling and pain.”
3. Compression: This refers to wrapping the injured area to prevent swelling. You can use an elastic medical bandage. Make the wrapping snug but not too tight. Over-tightening can interrupt blood flow. “Bandages or compression ‘sleeves’ are available at most drug stores,” says Mr. Depaola. “Swelling is going to be the main source of discomfort after any kind of injury.”
4. Elevation: Raising the sore body part above the level of your heart can reduce pain and throbbing. For example, you can put a sprained ankle on a pillow at a level above your heart. “Elevation is using gravity to limit swelling,” says Mr. Depaola. Elevation can also reduce bruising by making it more difficult for blood to reach the injury. Experts say it is best to elevate the affected area for up to 3 hours a day until the pain subsides.
If the pain or discomfort persists after going through the RICE steps, a sports medicine physician can evaluate the injury. Here’s what your physician can do:
• Diagnose the injury and give a good estimate of recovery time;
• Advise treatments;
• Customize a rehabilitation plan to the patient
• Ensure that rehabilitation will avoid a reinjury or an overcompensation injury;
• Provide recommendations for physical therapy;
• Provide performance-related advice for nutrition or supplements.
Tags: injury prevention, Miami Orthopedics & Sports Medicine Institute
R.I.C.E. for a Sprained Ankle?
Rice is great with stir-fry and it’s a perfect pairing for beans, but your plate isn’t the only place these four letters should appear in your health regimen.
It can also help you recover from an injury faster. No, eating rice will not help heal a sprained ankle, but R.I.C.E. will. This acronym stands for: Rest, Ice, Compression, Elevation. It’s the basic formula for taking care of sprained ankles and other minor injuries.
Here’s how to use R.I.C.E. to your advantage:
- Rest – If you sprain your ankle, stop all movement as soon as you possibly can. Never try to walk or stand on an injured limb.
- Ice – Sit down and have someone retrieve a bag of ice, frozen peas or a cold compress for you.
- Compression – Apply it directly to the ankle, using an ACE bandage (those stretchy, elastic bandages) to secure the ice. This will create compression over the injury site and reduce swelling.
- Elevation – Finally, elevate your foot above your heart by lying down and propping your ankle up on some pillows. Stay off of your foot for a few days if possible and your injury should heal nicely.
Following R.I.C.E. relieves pain, limits swelling, speeds healing, and protects the injured area. Knowing this simple formula is something you will use time and time again, whether for yourself or someone else. So just remember: It’s as easy as R.I.C.E.
R.I.C.E. Treatment: Rest, Ice, Compression, Elevation
RICE is a go-to mode of treatment for just about any injury, from repetitive stress injuries to torn or strained ligaments or muscles to stress fractures. Thus, a blog post on the RICE acronym is well overdue.
First off, the acronym RICE stands for rest, ice, compression, elevation. Rice treatment for injury is generally pursued with the goal of reducing the inflammation and swelling that coincides with injuries, ultimately allowing the injury to heal. In the article that follows, I will take you through each of the steps of RICE (rest, ice, compression, elevation) for a more detailed look at why each of these steps is pursued.
As soon as an injury occurs, it is important to stop doing the harmful activity and give the injured region a break. But it is not easy to rest certain areas of the body. In such cases, a support product might be helpful for minimizing pressure to a given region or immobilizing the injured area.
For instance, RICE treatment for sprained ankle might include the use of an ankle brace or crutches as most of us cannot afford to be bedridden to rest the ankle—not to mention, this would lengthen the recovery process as one would lose muscle and flexibility.
Another important thing to keep in mind relative to RICE injury treatment is that if a certain activity causes pain, you should stop doing it or take a break. Pushing through the pain will only cause additional damage over the long-term.
Applying ice is an important step of the acronym RICE. Ice should be applied immediately following an injury and during the recovery process. The benefits of ice are that it reduces pain and swelling and can slow bleeding (if applicable). Ice should be applied for 15 to 20 minutes several times a day the first few days following an injury. The ice should not be applied directly to the skin; blunt the cold by wrapping it in a towel or something of that nature.
If the skin turns white in response to the ice, one should stop treatment immediately. Also, those with a vascular disease, diabetes or diminished sensation should ask a doctor before applying ice; in such instances, ice may do more harm than good.
Compression is the next step in the acronym for RICE that is aimed at reducing swelling. A number of braces available at BraceAbility contain inserts that apply targeted compression. For instance, the Incredibrace Compression Athletic Bamboo Knee Sleeve takes care of both the rest and compression element of RICE for a knee injury.
Alternatively, one can use an elastic bandage to apply compression. When doing so, one must take care not to wrap the injured region so tight that the bandage reduces circulation. If the bandage is too tight, one might experience numbness or tingling in the limb, pain, swelling below the bandage or coolness. (Watch a video introduction to applying compression taping.) For some injuries, a compression sleeve is a simple alternative.
Elevation involves taking advantage of gravity as part of the RICE acronym injury treatment. Keeping the injured area above the heart can reduce swelling by allowing extra fluid to drain. When sitting down or icing the injured area, one should elevate the injured area on pillows.
Another important time when it is relatively practical to elevate the swollen limb is at night while one is sleeping. There are splints designed for such uses at night, such as the dorsal night splint for treating plantar fasciitis and other ankle conditions.
Rest, Ice, Elevation, Compression and …
Another add-on, if you will, to the rest, ice compression, elevation (RICE) steps is the use of non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil, Motrin) or naproxen (Aleve). As implied by the name of this drug category, they are helpful in reducing swelling and pain. Check out this guide for a complete anti-inflammatory shopping list.
Rest, ice, compression, and elevation are a good first start, but the steps of the RICE first aid acronym are not always enough to treat an injury. Therefore, if following these steps for several days does not cause the symptoms to improve, one should enlist the help of a medical professional.
In general, meet in the middle between rest and motion when caring for a sprain or strain.
RICE: rest, ice, compression, elevation.
MICE: motion, ice, compression, elevation.
How can two acronyms to treat a sprain or strain start with complete opposite steps – rest versus motion?
It’s all relative. Don’t practice absolute rest, and don’t overdue movement.
“For any acronym like this, you should use whichever is easiest for you to remember,” said Mary Repking, a Marshfield Clinic physical therapist.
Comparing RICE and MICE
As many doctors recommend RICE, as MICE. It’s more important to use the acronyms as guides rather than absolutes.
“In RICE, rest should really be defined as ‘relative rest,’” Repking said. “Don’t use the joint like you normally would. Give it time to heal.”
Similarly, the same is true for motion.
“It’s easy to be overcautious when you first get hurt,” she said. “Your instinct might be to stop moving the limb all together, which isn’t necessary. If you sprain your ankle, you can still work your knee and hip.”
In general, meet in the middle between rest and motion.
Rest means performing motions that don’t put so much stress or weight on the joint. A good example is writing the alphabet with your foot when you have an ankle injury.
“You can self-regulate this exercise,” Repking said. “Start with small letters and work toward larger letters as your ankle heals.”
This video series offers other range of motion exercises to help strengthen and keep your ankle flexibility as it heals.
Ice, compression and elevation
Remaining steps for each acronym are:
- Ice: Apply cold to the injury for a maximum of 20 minutes. Allow your skin to return to normal color before reapplying.
- Compression: Apply compression to hold the ice to the injury and after icing. This helps provide extra support which helps minimizes swelling.
- Elevation: Keep the limb 12 to 18 inches above the heart. This reduces blood pressure to the injured tissues and helps decrease swelling.
Some acronyms combine RICE and MICE, but switch the order. CRIME, for instance, means compression, rest, ice, motion and elevation.
Again, perform the method that works best for you when you need it.
When should you see a doctor?
If you can otherwise perform normal activities, sprains and strains will respond to this conservative care in two to three weeks.
“If you’re feeling progressively worse and can’t do normal activities like working a full day or walking to the bathroom on your own, the sooner you see your doctor, the better,” Repking said.
These acronyms do not apply when you hear a pop or tear at the time of injury. Both are reasons to get an X-ray, she said.
Additionally, you should monitor swelling. Significant swelling is good reason to see your doctor.
“Substantial swelling does not guarantee a break or tear, but it can be a good sign the injury’s more serious,” Repking said.
Recommended from Shine365:
Heat vs. ice? Learn more.
Four steps to ankle injury recovery (Video playlist)
About The Team
Bone and Joint Care Team
Our team wants to help you stay active. We’ll provide ways to manage pain and stiffness and prevent overuse, trauma and sports injuries to your bones, joints and muscles. We’ll also share the latest treatment information including total joint replacement and reconstruction.