Using RICE to Treat Your Acute Injury

In the sports medicine world, “RICE” is a well-known self-treatment for acute soft-tissue injuries. RICE stands for Rest, Ice, Compression, and Elevation. Like most things in life (especially performing arts medicine), RICE should be used in moderation, as too much of even just one of the segments can hinder healing and potentially cause additional tissue damage. The exact length of each segment depends on the severity, location, and stage of healing of your injury.

The best time to apply all four components of RICE is several hours after a severe acute injury before you have the injury evaluated by a medical professional. Unless you are specifically told to do so by a medical professional, you shouldn’t need to apply RICE more than 3-5 days following a severe acute injury (assuming you don’t re-injure yourself).


The key to understanding RICE is knowing that it focuses on the body’s blood vessels and how the body reacts to an injury. The body’s most prominent reaction to an acute musculoskeletal injury is swelling. However, not all swelling is bad. In fact, the body needs swelling to start the healing process. Unfortunately, sometimes the body goes a little overboard on producing swelling or something happens that interferes with the body’s ability to get rid of swelling when it is no longer needed in an injured area. RICE exists to try to keep the body from producing excessive amounts of swelling without interfering with the body’s natural healing process.

Rest

After an acute injury, rest protects your body from further physical damage, keeps you from interfering with the healing of your injury, and helps the overall healing process be as short and effective as possible. Resting limits the amount of physical activity in the injured area, thereby limiting the amount of mechanical stress placed on the cells in the area – both those that were damaged by the original injury and those that were brought in to heal the injury. Using a body part increases blood flow to the area. When that area is injured, this increased blood flow also leads to an increase in swelling production. Resting helps prevent this from happening.

However, “rest” does not mean stopping all activity. The type of rest that medical professionals are referring to when they are talking about RICE is not absolute rest, it’s relative rest. Additionally, you should only be resting after an acute injury until the pain and swelling go down. At this point, you can usually begin small range-of-motion exercises (without any external weight or resistance), but this should be approved by the medical professional directing your injury care first. It’s important to remember that you can start these range-of-motion exercises while still sitting out from your physical activities (again, think of this as relative rest).

Ice

Applying cold therapy, like ice, prevents further injury (in the form of tissue death caused by low levels of oxygen) and limits the amount of swelling being produced at the time the ice is applied. Applying ice shortly after a moderate to severe acute injury can limit excessive swelling (which interferes with healing), but applying ice immediately after an injury can actually interfere with the normal healing process by keeping the initial helpful swelling response to an injury from happening (or at least slow it down).

From a treatment standpoint, any kind of cold application works for RICE, but an ice bag allows you to do all four components simultaneously (if you sprained your ankle, you can’t elevate it while putting it in a cold whirlpool). Regardless of which type of cold application you choose, only treat your injury up to 20 minutes at a time as often as once an hour (but don’t feel that you have to ice your injury that frequently).

Compression

Applying compression to an injury is most often accomplished through an elastic bandage (“Ace wrap”) or a compression sleeve/sock. Compression treatment following an acute injury attempts to move the fluid accumulating near an injury (swelling) out of the injured area so that it doesn’t interfere with the healing process. To prevent redirecting the swelling into a more remote area of the body than the injury (like pushing the swelling from your ankle sprain into your toes), the compression wrap or sleeve should be applied with slightly more compression/tension at the point farthest away from the trunk.

The word “compression” can be misleading, as actually squeezing the heck out of your acute injury would impede healing, potentially cause further pain and injury, and could cut off circulation. An elastic bandage has enough elasticity in it to apply adequate compression with only a little stretch put on the bandage during application. If the bandage is stretched all the way before you put it on, it will end up squeezing your injured body part way too much.

If your injury is to one of your limbs, using light compression throughout the day can help protect the injury from aggravation while you move, can prevent excessive swelling, and can combat the effects of gravity on the swelling produced by the injury.

Elevation

The last part of RICE, elevation, is designed to counteract the effect of gravity on the swelling produced in response to an injury. Throughout the day, most of your body resides in a gravity-dependent position, meaning that your blood needs to go against gravity to return to your trunk. When your injured body part is in a gravity-dependent position for most of the day (like an injured ankle that is below the rest of your body), it is much harder for your body to remove the damaged cells and swelling from the injured area. Eliminating gravity – or, better still, using it to your advantage – by elevating your injury facilitates healing by helping your body keep your injured area clear of cellular debris that will interfere with the healing process.

The most effective way to take advantage of elevation’s benefits is to elevate the injured body part above the level of the heart. The easiest way to do this for a lower body injury is to lay on your back on the floor with your injured leg on a chair or couch. You do not need to keep your injury elevated all the time, but elevating the injury when you can helps prevent excessive swelling collection (in a gravity-dependent limb). Even if the injury is to the middle of the limb, make sure that the end of your limb is the highest point of your body while you are elevating your injury. This keeps the injury’s swelling from traveling to the end of your limb (i.e. having the swelling from your injured knee end up in your foot/ankle). Elevating an injury works the best at the end of the day and right after being active or standing for a long time.