Acute Injury Management

The Rest, Ice, Compress, Elevate (R.I.C.E) protocol is the go to response for most people when they injure themselves. Often ingrained from the days of P.E. in school it is universally accepted by the general population as a sensible thing to do.

However, since inception the research and science has moved on and while it’s unlikely to be harmful it might not be the best way to manage an injury (1). Let’s take a walk through to see how and why it’s changed.

Rest Movement
This is the biggest change, there are very few things that need to be completely rested, and even if one body part must be rested (e.g. fracture) there are still benefits to be gained from exercising the non-injured body parts. So think relative rest and keeping moving rather than resting completely.

Nature can teach us a lot about acute injury management as we know animals are capable of surviving and recovering from major injuries such as broken pelvises and amputated limbs as well as routinely recovering from more minor injuries. Following injury animals cannot rest completely, instead they must adapt and find a way to move that is least aggravating to the injured body part yet allows them to forage, hunt, avoid predators and find shelter.

This model has now been shown to be effective in humans with early mobilisation demonstrated to be superior to more conventional rehabilitation protocols for a range of conditions (2, 3). It’s worth noting that following total hip replacements physiotherapists will get patients up the same day or first thing the next day to start standing and walking. This early movement promotes healing of tissues in a way that is consistent with how they are used and likely has an important role in reducing the likelihood of pain persisting.

?? Ice, Compress & Elevate ??
These strategies are based on the idea that swelling is a bad thing. However, swelling is a natural part of the inflammatory process that is healing. We need that inflammation to facilitate tissue healing. So trying to completely eliminate swelling seems counter-productive. For acute injuries athletes are often now advised to avoid anti-inflammatory medications as they may slow the healing process (4).

A similar argument has been levelled at icing with claims that the constriction of blood vessels caused can also slow the healing process (1). However, on the other hand ice is an excellent analgesic and may help limit use of stronger pain relieving medications. Personally I have no problem with my patients using ice to manage pain but if it’s not something they find useful then it’s also fine to not use it!

I take a similar view on compression and elevation – if you feel they are beneficial then by all means use them. However they are not essential recovery strategies and movement is better than compression and elevation at improving fluid transport and reducing swelling!

Rather than R.I.C.E I now use the system proposed by Dr Jennifer Robinson (5) which is:

Movement: start easy and build gradually
Options: offer other options for cross training to keep active
Vary rehabilitation with strength, balance and agility drills
Ease back to activity early

This promotes a far more active approach to rehabilitation, helps to maintain fitness and results in better outcomes. So next time you pick up an injury think M.O.V.E. not R.I.C.E. Your body has developed incredible healing abilities over thousands of years of evolution so be confident it knows what it’s doing, but, if in doubt get it checked out!
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