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Acute Injury Management – RICE

If you’ve recently experienced a soft tissue injury, go see your doctor or physiotherapist as soon as possible to determine how serious your injury is and to find out how to allow swift and proper healing to occur.

In addition, the first 24-48 hours are very important following a soft tissue injury.   What you do or do not do in this time may or may not prevent unnecessary secondary tissue damage following the original injury.

"Yep... Ik ben erg goed in voetbal..." by Jan-Joost Verhoef under Licence CC BY 2.0
“Yep… Ik ben erg goed in voetbal…” by Jan-Joost Verhoef under Licence CC BY 2.0

When tissue damage has occurred, the cells of the affected tissue break open releasing their contents into the surrounding area.  This causes a whole set of inflammatory chain reactions that result in an increase in the blood supply to the area, further inflammation and swelling.  A certain amount of inflammation is necessary for your healing to occur, however, too much inflammation, bleeding and swelling cause more damage than the original injury alone.

If the principles of RICE are not applied quickly following a soft tissue injury, too much bleeding, inflammation and swelling will occur.  The side effects of this is that the swelling will cause compression of the surrounding tissue and reduce its oxygen supply.  This in turn can lead tissue damage of this surrounding tissue increasing the general weakness of the area.

Generally speaking, the principles of RICE should be applied to prevent this unnecessary extension of your soft tissue damage:

 

R – Rest

One of the most important things to do when you have an injury, is to rest the affected area immediately and to reduce your general activity as well.  This helps to reduce the general circulation of your body and in the injured area thus reducing the bleeding and swelling around your injury, helping to prevent secondary tissue damage.

Then, following your initial injury, you need to continue to rest the injured area through possibly restricted weight bearing and/or movement as determined by your doctor or physiotherapist according to the degree of your injury.

This is important since your body can’t heal if you keep straining your injured tissue.  Think of a bridge that has collapsed and is being repaired.  How helpful is it if people want to keep driving cars across it until it’s structurally sound again?  Tissue damage in the body is a lot like that metaphor.  If you place undue strain on a body part that hasn’t fully healed yet, you will cause mechanical failure of the injured tissue, placing you back at square one and possibly creating more damage.

The general guide to healing of injured tissue is 6 weeks to 50% healing and 3 months to 70-80% healing.  This is true for both bone and soft tissue.  Remember that ligaments and tendons also play a structural role in your body, so if you have injured 30%, 50%, 70% of your ligament or tendon, this will determine how much the rest of the remaining tissue will be available to take over the function of your damaged tissue.  This will also determine how much you need to rest it, if you need crutches, strapping, a brace etc.

 

I- Ice

Ice should be applied immediately following a soft tissue injury.  The application of ice helps to cause constriction of the blood vessels and limit further damage.  The ice will also lower the metabolic rate of the tissue that you apply it to, thus reducing the demands of oxygen and nutrients in the area.  This is useful since the circulation which is crucial in the function of tissue metabolism would have been damaged to some degree.

Another benefit of applying ice is that as it reduces the inflammation and swelling in the area, it will also reduce your pain and therefore any muscle spasm that would’ve occurred as the body tries to protect itself from unwanted movement.

Be careful not to apply ice directly to the skin or to use it for too long, you don’t want to  create ice burn.  The general recommendation is to apply the ice for 15-20 minutes every 1-2 hours.  Apply it less often over the 48 hr period following your injury as your swelling and inflammation reduces.  People who have poor circulation or a poor nerve supply to the area such as diabetics, smokers, people with paralysis, Raynaud’s disease, peripheral vascular disease etc. need to be careful when they use ice to avoid ice burn and tissue damage.

 

C – Compression

Compression of the injured area helps to reduce bleeding and swelling and the resulting secondary tissue damage if too much bleeding and swelling occurs.  It also helps in part to provide structural support to the injured tissue .

The trick with compression is not to apply it too tightly which can severely reduce blood supply to the area altogether and also result in tissue damage.

The skin should not be white, tingly or blue (all indications that the compression bandage is too tight).  The compression bandage should be placed in layers that partially overlap each other (about 50% overlap layer upon layer) and not in layers positioned directly over each other.  If the bandage is applied in the latter scenario, it is likely that the bandage will cause too much direct compression and substantially reduce the bloody supply to the area.

There are special strapping techniques to create support for certain ligaments and tendons that are damaged until they are healed that your physiotherapist can teach you.  If you’re not comfortable strapping, it might be better to buy an ankle support which won’t require you to know the intricate strapping methods and is more likely to be safe.  Just make sure that you buy the correct size for your joint.

 

E – Elevation

Again , elevation is there to help with the circulation.  Elevating the injured area helps to reduce the blood flow to the area, and thus the swelling.  It also helps to encourage the return of venous blood and lymph into the general circulation which helps with tissue healing.

 

Reference:

Khan K., Bruckner P., (2011).  Clinical Sports Medicine 4th Edition.  Australia. McGraw-Hill Australia