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R.I.C.E. (Rest, Ice, Compression, Elevation)

 R.I.C.E.  is an acronym (a word coined from first letters) for the most important elements—rest, ice, compression and elevation—in first aid for many injuries. This acronym appears repeatedly throughout this book—and in medical literature in general—in reference to athletic injuries. Use the word R.I.C.E. to jog your memory when you are faced with almost any athletic injuries like bruises, sprains, strains, dislocations or uncomplicated fractures.  Some authors use PRICE - adding Protection, or bracing, to the acronym.

REST

Stop using the injured part, and rest it as soon as you realize an injury has taken place. Continued exercise or other actively could cause further injury, delay healing, increase pain and stimulate further bleeding. Use crutches to avoid bearing weight on injuries of the foot, ankle, knee or leg when significant swelling or pain occurs. Use splints or protective taping for injuries of the hand, wrist, elbow or arm. After medical treatment, the injured part may require immobilization with splints or a cast to keep the area at rest until it heals properly.

ICE

Ice helps stop internal bleeding from injured blood vessels and capillaries. Sudden cold causes small blood vessels to contract. This contraction of blood vessels decreases the amount of blood that can collect around the wound. The more blood that collects, the longer the healing time that is required. Ice can be safely applied in several ways using the following instructions:  

·      For injury to a small area, such as a finger, toe, foot, ankle or wrist, immerse the injured area in a cup or bucket of ice water. Use ice cubes or crushed ice with enough water to allow mobility in the slush.

·      For injury to a larger area, use ice packs. Avoid placing ice directly on the skin. Before applying the ice, place a wet towel, cloth, or one or two layers of an elasticized compression bandage (Ace bandage) on the skin to be iced. To make the ice pack, put ice chips or ice cubes in a plastic bag, or wrap them in a thin wet towel. Place the ice pack over the cloth. The pack may sit directly on the injured part, or it may be wrapped in place with an ACE bandage or saran wrap.

·      Ice the injured area for 15-20 minutes (no matter what form of ice treatment you are using).

·      Remove the ice to allow the skin to warm for 40-45 minutes (until the area is warmed again.

·      Reapply the ice.

·      Repeat the icing and warming cycles for 3 hours while following the instructions below for compression and elevation. Your doctor may change the icing schedule after the first 3 hours. Regular ice treatment is usually discontinued after 72 hours or the swelling is well under control (the area is black & blue). At that point, contrast baths of the injured area—alternating 5 minutes ice, 5 minutes of hot weather, and finished with 5 minutes of ice water – works well to help pump out waste products around the injured area, and relieve pain.

·      When pain allows, ‘write’ the letters of the alphabet with the injured area while in the ice slush.  Start with very small movements, and gradually increase the amount of movement until you have full, sweeping strokes.  If it hurts too much, you are going too far, but by starting movement right away, you speed healing and decrease the amount of scar tissue you will eventually have. 

COMPRESSION

Compression decreases swelling by slowing bleeding and limiting the accumulation of blood and plasma near the injured site. Without compression, fluid from adjacent normal tissues seeps into the injured area. The more blood and fluid that accumulate around an injury, the slower the healing takes. Following are instructions for safely applying compression to an injury: 

·      Use an elasticized bandage (Ace bandage) for compression, if possible. If you do not have one available, any kind of cloth or elastic tape (Elasticon) will suffice for a short time. Wrap the injured part firmly, wrapping over the ice also. Begin wrapping below the injury site, and extend above the injury site (toward the heart).

·      Be careful not to compress the area so tightly that the blood supply is impaired. Signs of blood supply deprivation include pain, numbness, cramping and blue or dusky-colored nails. Remove the compression bandage immediately if any of these symptoms appears. Leave the bandage off until all signs of impaired circulation disappear. Then rewrap the area—less tightly this time.  

ELEVATION

Elevating the injured part above the level of the heart is another important way to decrease the swelling and pain at the injury site. Elevate the iced, compressed area in whatever way is most convenient. Prop an injured leg on solid objects or pillows. Elevate an injured arm by lying down and placing pillows under the arm or placing them on the chest with the arm folded across. The whole upper part of the body may be elevated gently with pillows or a reclining chair or by raising the head of the bed on blocks.