RICE Method for Injury

What is the RICE method?

The RICE method is a longstanding protocol for caring for musculoskeletal injuries. RICE stands for Rest, Ice, Compression and Elevation. These steps can help reduce acute inflammation and pain in your soft tissues. Healthcare providers have long recommended the RICE method as a quick and accessible way to feel better after an injury. It can also help to control severe swelling and bleeding when necessary.

The RICE method treats acute inflammation in your soft tissues, like your muscles, tendons and ligaments. Acute soft tissue injuries include sprains, strains and contusions. These are often sports injuries. Chronic injuries include tendinitis and bursitis. These are often repetitive strain injuries.

Injuries to your bones and joints, like fractures and dislocations, can also affect your soft tissues. These injuries will likely need other treatments, but the RICE method can help before and after. If you’re not sure what type of injury you have, you can use the RICE method until you get a medical diagnosis.

What does RICE (Rest, Ice, Compression, Elevation) mean?

Here’s what the RICE method means for treating an injury:

Rest

Resting after an injury or surgery is a natural response. It gives your body the chance to regroup while your immune system sends resources to start the healing process. If you have a chronic injury from repetitive stress and strain on your tissues, that injury also can’t begin to heal until the strain stops. Appropriate rest allows your tissues to begin to rebuild without new trauma interrupting the process.

Ice

Ice in this protocol stands in for any kind of cooling therapy (cryotherapy). Healthcare providers have suggested applying ice packs or cold packs to an injury, immersing it in an ice water bath and other methods. Cold causes your blood vessels to constrict and numbs your tissues. Healthcare providers recommend it in brief, 10-minute intervals for pain relief and to help stop bleeding from trauma.

Compression

Compression means applying gentle pressure to an injury by wrapping it in cloth. Healthcare providers often use a stretchy fabric called a compression bandage. Wrapping your injury can help control severe swelling (edema). While swelling is part of the healing process, sometimes a healthcare provider needs to reduce it before they can treat your injury. Compression can also prevent a wound from reopening.

Elevation

Elevation means resting your injured part at an elevated level — if possible, above the level of your heart. This slows blood flow to the injury. The idea is to lower blood pressure and limit bleeding at the site of the injury. It also encourages drainage from your lymphatic system to reduce swelling. Elevation might not be helpful if you don’t have a lot of swelling or bleeding, but it can be helpful if you do.

What are the benefits of the RICE method for treating injuries?

Each of the steps in the RICE method reduces acute inflammation in your soft tissues by different means. When used together, these steps can provide immediate pain relief and control swelling and bleeding. This is useful when pain, swelling or bleeding are severe and you’re waiting for other treatment. Reducing the swelling might make it easier for your healthcare provider to treat your injury.

What are the disadvantages of the RICE method?

While there are times when your provider might want to briefly control inflammation in your tissues, inflammation also has an important role to play. Your injury can’t begin to heal until the inflammation cycle completes. Healthcare providers caution that if you reduce it too much, it might delay the healing process. This concern has led to some recent amendments to the original RICE method guidelines.

What are some of the recent amendments to the original RICE method?

Healthcare providers now recommend the steps in the RICE method with some caveats. For example:

• Rest. Rest is important after an injury, but it’s also important not to rest too completely or for too long. Providers recommend you don’t put stress or strain on your injured part for a few days. After that, you should begin gradually increasing movement, stopping if you’re in pain.
• Ice. Use ice or other cryotherapy only in the first eight hours after injury (or manual treatment for that injury). It’s good for pain relief and bleeding control, but it can interrupt the healing process. Apply ice with a skin barrier, and only for 10- to 20-minute intervals every hour or two.
• Compression. There’s no clear evidence to support compression for the average injury, but none to persuade against it either. If you have a lot of swelling or bleeding, it can help. Don’t wrap it too tightly — you don’t want to inhibit blood flow. Look out for numbness or tingling.
• Elevation. Elevation is another part of the protocol that’s neither been proven nor disproven. Most agree that it won’t hurt and might help. It helps to drain swelling and can slow the blood flow to the area to relieve throbbing and bleeding. Elevate the injured part above heart level.

Some healthcare providers have suggested some minor changes to the acronym. For example, instead of RICE, it should be MICE (Motion, Ice, Compression, Elevation) or RACE (Recover Actively, Compress and Elevate). What these changes have in common is emphasizing some movement instead of total rest.

When should I see my healthcare provider about an injury?

It’s never a bad idea to see a healthcare provider after an injury to check for damage that you might not be aware of. Be sure to call if you’ve tried to treat it at home and it’s not improving or getting worse.

See your provider right away if you have alarm symptoms, like:

• Severe pain that you can’t relieve
• Difficulty moving or putting weight on the injured part
• The part looks visibly misshapen
• Severe swelling with redness and heat
• Nerve-related symptoms, like numbness or tingling

Is the RICE method still recommended?

Yes and no. Some healthcare providers don’t recommend it at all anymore, arguing that there’s no evidence to support it. Others say it’s still helpful, but they’ve modified the guidelines for using it a bit.

It’s true that the RICE method wasn’t originally based on clinical evidence. In fact, the doctor who originally described it later recanted his recommendation, admitting that it wasn’t well-founded. On the other hand, there’s plenty of observational evidence that the RICE method works to reduce inflammation. The argument is about whether reducing inflammation is actually helpful or not.

Some healthcare providers worry that reducing inflammation might delay your recovery by interrupting the healing process. For example, swelling after an injury is a normal part of that process. The fluid that causes swelling is a waste product of injured cells. That waste must accumulate and drain through your lymphatic system before healing can begin. Preventing swelling could prevent the waste from draining.

Most soft tissue injuries do heal, regardless of the RICE method. But occasionally, some injuries can resist healing or keep coming back. Some researchers have suggested that the RICE method might contribute to these chronic injuries. Others suggest that skipping the RICE method might speed up healing. Athletes who want to return to the field might prefer this to the short-term relief it offers.

With research ongoing, many healthcare providers still recommend the RICE method, but they’re more specific now about how to apply it. In many cases, the RICE method may still be appropriate for immediate relief after an injury, but not for long-term recovery. Sometimes, reducing pain, swelling or bleeding is the most immediate medical priority. Other times, a different protocol might work better.

What are the alternatives to the RICE method for treating an injury?

In recent years, healthcare providers have suggested some new, alternative protocols for treating soft tissue injuries at home: MEAT, and PEACE & LOVE. They recommend these for long-term recovery after the acute phase of your injury (the first 72 hours). You may still use the RICE method in the acute phase.

MEAT injury method

MEAT stands for:

• Movement. Gentle movement from time to time encourages blood flow to your injured tissues to promote healing. Let pain be your guide as to how much movement is too much, too soon.
• Exercise. As you begin to heal, you may begin to introduce specific, controlled exercises to help rehabilitate your injured part. A physical therapist can show you what to do, and how.
• Analgesia. Analgesics are pain relievers. You may need to continue to use pain relievers during your recovery to allow for enough healthy movement. Follow your healthcare provider’s advice.
• Therapy. Therapy encompasses the many long-term treatments you may need to fully recover from an injury. Your provider might recommend orthotics, bodywork or other modalities.

PEACE & LOVE injury method

PEACE & LOVE stands for:

• Protection. To protect the injury during healing, you might need to wear a cast, brace or splint.
• Elevation. While resting your injury, keep it elevated to reduce blood flow and swelling.
• Avoid anti-inflammatories. Providers now recommend pain relievers that don’t suppress inflammation after the first few days of recovery. That means acetaminophen instead of NSAIDs.
• Compression. A compression bandage on your injury can reduce swelling and bleeding.
• Education. This is to remind healthcare providers to educate you about your role in your own recovery. Specifically, they should encourage you to play an active rather than passive role.
• Load. Loading means gradually returning some mechanical load (weight or stress) to your injured part. Your provider might refer you to a physical therapist to guide this process.
• Optimism. Research has found that a positive approach to recovery can affect your prognosis (outlook). Believe in your own capacity to heal, and don’t neglect your mental health during recovery.
• Vascularization. This means increasing blood flow to your injured tissues. While you might use ice and compression to reduce blood flow earlier on, blood flow can help with healing later on.
• Exercise. Physical therapy can help restore strength and flexibility to your weakened tissues. This can help prevent reinjury as you return to your activities, especially for unstable joints.