The RICE protocol is commonly used to treat sports injuries in the first 48 hours following injury. Ligaments, tendons and muscles are referred to as the bodies ‘soft tissues’. When soft tissues get injured through whatever means they bleed to different extents depending on the blood supply to that particular tissue and the structures around it. An inflammatory reaction is also triggered in the area. These two events combine to cause swelling. If this swelling is not controlled it can further contribute to tissue damage by causing what is known as secondary hypoxic injury. What this means is that the tissue is denied its supply of oxygen and this is not good news!
The aim if the RICE protocol is to control swelling and minimise further tissue damage. It does this by reducing blood flow from blood vessels around the injury and decreasing fluid coming from the damaged cells. If done correctly and in time it can considerably shorten recovery from injury. Before anyone runs for the Uncle Bens it should be explained that RICE stands for Rest, Ice, Compression and Elevation. Each of these plays an important role in immediate injury management as follows.
Rest, you would imagine, should be the first thing someone with an injury does but unfortunately this word does not feature in the vocabulary of most GAA players. Rest infers that the injured party immediately stops what they are doing in an effort to prevent further damage. All too often the first reaction of the injured person is to try to play on for a few minutes and see how it goes. Just because the pain may settle a little as someone plays on with an injury this does not mean that the injury is suddenly disappearing. It means that you are over-riding the pain stimulus through physical and mental processes. If the rest part of RICE is not adhered to the injury will be inevitably prolonged.
Ice is the most widely used treatment modality for acute sports injuries. It can be applied in various ways which include an ice pack, a cryocuff, submerging the area and using carbon dioxide gas. These methods all have the same aim which is to reduce the temperature of the injured tissues. This causes the blood vessels to narrow which reduces the amount of blood going to the injury site which in turn reduces the swelling. Ice also reduces the pain by over-riding the nerve endings that transmit pain. Ice reduces muscle spasm and decreases the chances of cell death by slowing the metabolism of the injured cells. Ice should be applied for 20 minutes every two hours for the first 48 hours following injury. Icing for longer runs a risk of cell death so should be avoided.
Compression following injury is actually a more important component of RICE than ice. Compression applied properly helps minimise swelling. It is really important not to apply compression too tightly as this too can cause further damage by cutting off circulation completely. Compression should only be applied using an elastic bandage so it can expand slightly if the swelling continues. The ideal scenario is to compress the area with something such as a cryocuff which allows the area to be cooled at the same time.
The final component in RICE is elevation. This also aims to reduce swelling by raising the area above the level of the heart to minimise blood flow to it using gravity. This can also decrease pain by decreasing the pressure on the area. The injured area should be elevated as much as possible during the first 48 hours following injury.
In an ideal world an injured player will come off immediately when injured, will have an ice bag and an elastic bandage in their gear bag, will compress and elevate the area as much as possible for the first 48 hours and will ice the area for 20 minutes every two hours following the injury. Recent research has suggested that avoiding anti-inflammatory medication for the first 48 hours following injury is also a good idea as it impedes the initial healing reaction.