RICE(D) principles are part of the acute management of soft tissue injuries, sporting or otherwise. RICE(D) stands for rest, ice, compression, elevation and diagnosis. The following is a brief summary of each principle.
Rest immediately from the physical activity to protect the area from further damage. This gives time to assess the extent of the injury and minimize aggravating the injury through a process known as “the pain gate theory”.
During exercise, nerve impulses that are sent due to mechanical stress such as touch can override the impulses that are sent from the pain nerves. For example, rubbing the injured area when it is sore can help to alleviate some of the pain.
Other factors can influence the ability to continue playing through an injury including the presence of adrenaline, a player’s focus on the game at hand, the type of tissue involved and the severity of the injury.
It can be a risk to continue playing because those things described above are not always immediately apparent. Adopting a ‘playing through it’ mentality may result in a worsening of the injury and longer rehabilitation.
Use ice to reduce swelling, pain and inflammation for 48-72 hours post-injury. Apply the ice pack for 10-20 mins up to every hour. Do not apply ice directly to the skin. Place a wet towel between the skin and cold material to prevent irritation of the skin.
Icing acts to:
- Constrict the blood vessels to decrease bleeding in the tissue;
- Reduce pain (pain gate theory);
- Reduce muscle spasm;
- Reduce the risk of cell death (also called necrosis) by decreasing the rate of metabolism.
There are a small number of areas that you should not apply ice to for various reasons. These are the neck, the outside bone of the elbow, the collar bone (upper end), the front of the hip (bony part) and the outer bone of the knee. There is a superficial nerve just below the skin in these areas that can be damaged by applying ice to it. Ice should also not be applied to the area of the kidneys which is just below the ribs towards the back. If in any doubt, consult a medical professional.
Apply compression to an injured area for the first 24 to 72 hours post-injury. Compression acts to minimize swelling in two ways:
- Increase pressure at the injured site to constrict the blood vessels and decrease bleeding;
- Minimise the amount of fluid an injured tissue can produce, reducing the overall healing time.
Compression should feel comfortable and not restrictive. When applying a wrap bandage, begin the wrap at the point furthest away from the heart to set up a pressure gradient away from the injury. In case of over-compression, do not wear at night. Signs of over-compression include numbness, tingling, increased pain, coolness, or swelling below the bandage.
Consult a physiotherapist if you think you need to use a wrap for longer than 48 to 72 hours as a more serious problem may be present.
For the first 48-72 hours post-injury, when at rest or when icing, try to keep the area at or above the level of your heart to minimize swelling. Elevation allows gravity to drain the fluid away from the injured site.
In ankle injuries, elevate the foot above the hip in sitting or lying and in upper limb injuries, keep the arm elevated on pillows or using a sling.
An accurate diagnosis is essential for proper rehabilitation of moderate to severe injuries. Consult a medical professional (doctor or physiotherapist) if you are worried about the injury or if the pain or swelling has not gone down significantly within 48 hours.