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RICE Method

 

The R.I.C.E method (resting, ice, compression, elevation) is one of the most recommended first-aid therapeutic treatments for acute musculoskeletal injuries, such as sprains and strains. It is a common method, used in the treatment of injuries and is mainly used to help reduce inflammation and swelling, reduce recovery time and provide basic pain relief. It can be applied in many injuries, especially in the recovery of the ankle area, in the sports field. It should be given as soon as possible after the injury. This will result in decreased pain, inflammation, muscle spasms, swelling and tissue damage. The therapy can be performed together, separately or in any combination of components of the four elements of the art. It is one of the methods most used in physiotherapy given its easy application, since it can be performed with few materials and practically anywhere. Your application only includes four steps.

It is an already very old method, however some consider it already obsolete. What is your opinion and evidence of the application of this method?

  

1. Rest :

 

 

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It is important, after an acute injury, to rest the affected area to protect it from further injury. The area should be protected from overcharging, but should not be completely inactive. Complete inactivity will result in excessive decreases in the strength and mobility of affected soft tissues and promote increased swelling. The load must be within the capacity of the affected tissue when the load is greater than the capacity, it can cause more damage or adversely affect the recovery of the affected tissue. It is important to determine the appropriate amount of stress that tissues can handle in order to promote a faster recovery.

 

 
  

 

2.  Ice:

 

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Ice therapy, also known as cryotherapy, is the application of cold as a therapeutic modality. Cold stimulates vasoconstriction of blood vessels in the area being treated. This reduces swelling and inflammation by limiting the amount of fluid capable of perfusing soft tissue in the vicinity of the lesion. It also numbs the affected area, slowing down the spread of nociceptive neural stimuli in the brain, to reduce pain and muscle spasms.

 

Application advice:

The ideal is to use an ice pack, but anything frosty can be useful as for example a bag of congealed peas. Ice should be wrapped in a damp cloth or towel to prevent superficial damage to the nerves or skin caused by excessive exposure to ice.

Ice should be applied for 15 to 20 minutes every two hours in the first 48 hours after injury. The maximum time of application of ice is 20 minutes, since more than this can cause injuries in the skin and in the more superficial tissues. Nowadays, it is indicated to apply the ice for 8 minutes, to rest 3 minutes and to reapply another 8 minutes.

 

Additional Care:

Cryotherapy should be used in people who are hypersensitive to cold, particularly those with Raynaud's syndrome, diabetes, cold urticaria, paroxysmal cold hemoglobulinuria, or circulatory failure.

 

There are positive and negative aspects associated with cryotherapy:

 

Negative effects

- Decreased local metabolism.

- Low enzymatic activity.

- Reduced oxygen consumption, important for tissue regeneration.

- Reduced flexibility because the cold provides rigidity and reduced elasticity of the connective tissue of the muscles.

 

Positive effects

- Reduces the amount of bleeding due to vasoconstriction at the site of the injury and decreases swelling, because the cold decreases the amount of blood that arrives in the injured area. - Reduces pain. - Reduces muscle spasm.

 

In the acute stages of injury, the positive effects of cryotherapy outweigh the negative effects and allow the inflammatory reaction to be controlled.

Cryotherapy should not be prolonged excessively, so that the negative aspects of cryotherapy do not prevent tissue recovery.

There are products that do not replace ice in the acute phase of the injury, but can be used later during recovery. As for example, the cold spray, or the cold gels like the biofreese, polar frost, physiocrem.

 

Ice VS Heat

Ice should be used initially to minimize the inflammatory reaction after acute injury. After 72 hours, the initial chemical inflammatory reaction will decrease and the effects of heat will be more beneficial than the effects of ice. It can be used in the form of a spray, a salve or a compress. The heat will result in increased circulation, relaxes muscle tension and reduces joint stiffness. In addition, it will also help prepare rehab tissues.

 

 

3. Compression:

 

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Compression of the injured area helps to immobilize and protect the joint. It also helps to reduce swelling in the area by increasing pressure within the tissues, which results in decreased soft tissue perfusion, which helps to prevent excessive swelling. Bandages or braces (https://mipmed.com/index.php?_route_=blue-elastic-strap-with-velcro-8x40cm.html) can be used as compression devices. There are several types of bandages: non-adhesive elastic bandages (https://mipmed.com/index.php?_route_=non-adhesive-elastic-bandage-5cm-x-5m.htm), cohesive elastic fixation bandages (https: //mipmed.com/index.php?_route_=Cohesive-bandage--7,5-cm-x-4,5-m), adhesive compressives (https://mipmed.com/index.php?_route_=elastic -adhesive-bandage-superplast-interior-adhesive-5cm-x-4-5m-like-elastoplast.html), non-adhesive crepe (https://mipmed.com/index.php?_route_=crepe-bandage.html&search= bandages & description = true).

Important Note: When compression is tight, it can hamper blood circulation and can cause pain, decreased blood flow and / or neurological signs and symptoms to compressed tissue or tissues distal to it. therefore, limb crunching should be avoided.

 

 

4. Elevation:

 

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The injured area should be immediately lifted, preferably above the heart. This allows gravity to drain excess fluid around the injured tissue back into the central circulation, resulting in decreased swelling. As the pressure on the injured area is reduced, this reduces pain and allows the transport of cellular waste products to the heart, which helps to recover tissue, restoring cellular and extracellular homeostasis.

 

Important Advice:

After 48 hours of using this method, the recovery of the injury begins, but if after this period there is no improvement in pain and swelling, it is advisable to be seen by a doctor.

In the recovery period, gentle massages with a massage oil (https://mipmed.com/index.php?_route_=sweet-almond-oil-500ml.html) or with a heat effect massage cream (https : //mipmed.com/index.php? _route_ = chemotherm-500ml.html) may accelerate the formation of scar tissue, shorten recovery time and reduce recurrence.

Another action that may accelerate the injury recovery process is to do light stretching as soon as there is no edema. However be careful not to overdo it, the person may not feel pain while stretching, to avoid the risk of restarting the injury.

After the acute phase and in the absence of edema or bleeding wound, heat can be used to increase local blood circulation and aid healing.

 

Complement reading this post by viewing the following videos:

RICE Method: https://www.youtube.com/watch?v=o40cZt9bcWg Ice Usage: https://www.youtube.com/watch?v=sLQbQUA2vs4

 

Sometimes variations of the acronym RICE are used to emphasize additional steps that must be taken. These include:

"HI-RICE" - Hydration, Ibuprofen, Rest, Ice, Compression, and Elevation

"PRICE" - Protection, Rest, Ice, Compression, and Elevation

"PRICE" - Pulse (Typically Radial or Distal), Rest, Ice, Compression, and Elevation

"PRICES" - Protection, Rest, Ice, Compression, Elevation, and Support

"PRINCE" - Protection, Rest, Ice, NSAIDs, Compression, and Elevation

"RICER" - Rest, Ice, Compression, Elevation, and Referral

"DRICE" - Diagnosis, Rest, Ice, Compression, and Elevation

"POLICE" - Protection, Optimal Loading, Ice, Compression, and Elevation

 

Catarina Vilela (nurse)

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