RICE treatment is important as a first-line therapy for many types of injuries and trauma.
What is RICE?
RICE is an acronym that refers to a treatment involving rest, ice, compression, and elevation. It is used for strains and sprains. Rest is performed for 24-48 hours after the injury. This means that there needs to be less activity, especially concerning actions that cause pain. Slings, splints, and crutches may be needed for the “rest”. Ice is also used for about 48 hours after the injury. Icing with frozen bagged vegetables, or an ice pack, for 20 minutes at a time, about every 4 hours, is important. Icing should never be used over 20 minutes per session, due to the risk of damaging tissues. Compression is needed “when elevating a sprain or strain in early treatment”. Typically, an ACE bandage, wrapped in an overlapping manner so that it is snug, is the common method to use. It is crucial not to make the bandage so tight that circulation is cut off or if the extremities become cold, tingly, or blue. Elevating the injured area above the heart, or with pillows, even during sleep, can also help the sprain or strain heal.1 RICE is not a cure for soft tissue damage, but it is a “first-aid treatment”. Its purpose is to manage internal bleeding and discomfort. Rest and ice are both necessary for reducing inflammation. Compression is vital to decreasing edema. Some patients may benefit from compression sleeves or stockings, especially in post-operative or chronic conditions. Elevation will also reduce the risk of edema.2
Variations of RICE
There are some other variations on the RICE treatment plan. HI-RICE refers to “hydration, ibuprofen, rest, ice, compression, and elevation”. PRICE is “protection” or “pulse” with rest, ice, compression, and elevation. PRICES adds in support, PRINCE includes NSAID medication, RICER, tacks on term “referral”, DRICE adds “diagnosis” to the mnemonic device, and POLICE stands for “protection, optimal loading, ice, compression, and elevation”.3 Cold compression therapy incorporates a “combination of cryotherapy and static compression” to treat the pain and inflammation after surgery or acute injury. In cryotherapy, cold is used in a therapeutic setting. Using ice with compression makes the treatment “significantly colder than ice alone due to improved skin contact”. The tissue cools faster and maintains its cold longer after the treatment ends. Continuous Cold Therapy Devices (“ice machines”) are pads that have circulated ice water, but they may cause tissue damage due to overcooling and poor temperature control. Lawsuits are pending with those devices due to reported cases of frostbite and amputations. Safer options are cold compression wraps, which contain a gel or ice, and are re-freezable. They don’t exceed the safe amount of cooling time, and these wraps often have adjustable straps to “aid in compression”. Wraps also have a protective layer to prevent ice from directly touching the skin and causing “cryoburn”.4