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RICE is best for Soft Tissue Injuries

Rest, Ice, Compression and Elevation best for acute injuries

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Updated April 04, 2014

First Aid for Sports Injury

First Aid for Sports Injury

(c) Jamie McDonald/Getty Images
If you suffer an injury such as a sprain, strain, muscle pull, or tear, immediate first aid treatment can prevent complications and help you heal faster. One of the most popular acronyms to remember if you get a sports injury is RICE, which stands for Rest, Ice, Compression and Elevation. Using these immediate first aid measures is believed to relieve pain, limit swelling and protect the injured soft tissue.

Soft Tissue Injuries

When an injury occurs, damaged soft tissue may bruise, swell or bleed (externally or internally) and become inflamed. Healing occurs as the damaged tissue is replaced by collagen, perhaps better known as scar tissue. In most cases the tissue needs complete repair before you should return to sports.

The RICE Method of Acute Injury Treatment

  • Rest: Rest is vital to protect the injured muscle, tendon, ligament or other tissue from further injury. If injured, stop playing and protect the injured part from further damage. Avoid putting weight on the injured part, get help moving to a safe area off the field. Resting the injured part is important to promote effective healing.

  • Ice: When icing an injury, choose a cold pack, crushed ice or a bag of frozen peas wrapped in a thin towel to provide cold to the injured area. An ice massage is another extremely effective way to direct cold to the injured tissue.

    Cold provides short-term pain relief and also limits swelling by reducing blood flow to the injured area. When icing injuries, never apply ice directly to the skin (unless it is moving as in ice massage) and never leave ice on an injury for more than 20 minutes at a time. Longer exposure can damage your skin and even result in frostbite. A good rule is to apply cold compresses for 15 minutes and then leave them off long enough for the skin to re-warm. (Also see: The Proper Use of ICE).

  • Compression: Compression helps limit and reduce swelling, which may delay healing. Some people also experience pain relief from compression. An easy way to compress the area of the injury is to wrap an ACE bandage around the swollen part. If you feel throbbing, or if the wrap just feels too tight, remove the bandage and re-wrap the area so the bandage is a little looser.

  • Elevation: Elevating an injury help control swelling. It's most effective when the injured area is raised above the level of the heart. For example, if you injure an ankle, try lying on your bed with your foot propped on one or two pillows.

After a day or two of treatment, many sprains, strains or other injuries will begin to heal. But if your pain or swelling does not decrease after 48 hours, make an appointment to see your primary care physician or go to the emergency room, depending upon the severity of your symptoms.

Once the healing process has begun, light massage may reduce the formation of scar tissue, and improve tissue healing.

Gentle stretching can be begun after all swelling has subsided. Try to work the entire range of motion of the injured joint or muscle, but be extremely careful not to force a stretch, or you risk re-injury to the area. Keep in mind that a stretch should never cause pain. For proper stretching technique, review Flexibility Exercises.

Heat may be helpful once the injury moves out of the acute phase and swelling and bleeding has stopped. Moist heat will increase blood supply to the damaged area and promote healing.

Finally, after the injury has healed, strengthening exercises can be begun. Start with easy weights and use good form.

It's helpful to work with your physician, a physical therapist or an athletic trainer as you begin injury rehab. Expert guidance can help you progress quickly, without overdoing it. Your best option is to choose a rehab expert who has experience working with athletes and is familiar with your sport.

Inflammation and Healing

In 2010, a study was published that found that some inflammation is needed for tissue healing. Professor Lan Zhou lead a team at the Neuroinflammation Research Center at the Cleveland Clinic in Ohio, found that inflamed cells produce IGF-1, (insulin-like growth factor-1), a hormone which increases the rate of muscle regeneration and helps heal damaged tissues.

The study has started discussion in the medical community about the benefits and limitations of managing inflammation as a method of encouraging healing. Gerald Weissmann, the editor of the journal that published the study was quoted in the Telegraph saying "For wounds to heal we need controlled inflammation, not too much, and not too little. It's been known for a long time that excess anti-inflammatory medication, such as cortisone, slows wound healing. This study goes a long way to telling us why – insulin-like growth factor and other materials released by inflammatory cells helps wound to heal."

At present, the PRICE treatment approach is still being recommended by most experts, although many are waiting for further research to help sort out the controversy.

Sources

Ankle Sprains: How to Speed Your Recovery. American Orthopaedic Society for Sports Medicine, [http://www.sportsmed.org] 2008.

Hold the Ice? Learner Research Center News, October, 2010.[http://www.lerner.ccf.org/news/2010/10/3.php] last accessed Jan. 2011.

Hubbard TJ, Denegar CR. "Does Cryotherapy Improve Outcomes With Soft Tissue Injury?" J Athl Train. 2004 Sep;39(3):278-279.

Lu H, et al. Macrophages recruited via CCR2 produce insulin-like growth factor-1 to repair acute skeletal muscle injury. Federation of American Societies for Experimental Biology, Nov 2010. [Contact zhoul2@ccf.org].

Sports Injuries: Initial Treatment), Merck Manual online [http://www.merckmanuals.com], last accessed Jan 2010

Safe Exercise: First Aid Guidelines, American Orthopaedic Society for Sports Medicine, October 2007.

Related Video
How to Ice a Running Injury
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