RICE: Food for Thought

Mar 11

Cold Comfort

Chances are, if you’ve had an ankle fracture or surgery, you’ve heard of RICE—an acronym for Rest, Ice, Compression, and Elevation, and a standard orthopedic recommendation since 1978. The benefits of RICE are:

Rest: Immobilization prevents further injury and gives the body time to recover.
Ice: Cold reduces pain by numbing the affected area.
Compression: Pressure keeps swelling under control.
Elevation: Keeping the injured body part above the heart reduces swelling and the associated pain and discomfort.

Serving Up Better Options

However, RICE’s use has been debated and revised since the mid-2010s.

Medical News Today says, A review of studies conducted in 2012 found that there was not enough data to prove that the RICE method effectively treated sprained ankles.
A 2015 review associated with the Red Cross confirmed that ice was effective immediately after an injury. However, the researchers determined that immobilizing an injured limb may not be helpful. They found no evidence to support elevation. They also found indications that compression may not aid strains or sprains.

The Cleveland Medical Clinic notes some of the recent amendments to the original RICE method.

Rest. Rest is important after an injury, but it’s also important not to rest too completely or for too long. Providers recommend you don’t put stress or strain on your injured part for a few days. After that, you should begin gradually increasing movement, stopping if you’re in pain.
Ice. Use ice or other cryotherapy only in the first eight hours after injury (or manual treatment for that injury). It’s good for pain relief and bleeding control, but it can interrupt the healing process. Apply ice with a skin barrier, and only for 10- to 20-minute intervals every hour or two.
Compression. There’s no clear evidence to support compression for the average injury, but none to persuade against it either. If you have a lot of swelling or bleeding, it can help. Don’t wrap it too tightly — you don’t want to inhibit blood flow. Look out for numbness or tingling.
Elevation. Elevation is another part of the protocol that’s neither been proven nor disproven. Most agree that it won’t hurt and might help. It helps to drain swelling and can slow the blood flow to the area to relieve throbbing and bleeding. Elevate the injured part above heart level.

Some healthcare providers have suggested some minor changes to the acronym. For example, instead of RICE, it should be MICE (Motion, Ice, Compression, Elevation) or RACE (Recover Actively, Compress and Elevate). What these changes have in common is emphasizing some movement instead of total rest.

Yale Medicine points out the physician who developed RICE even changed his position in 2015, saying that rest and ice can possibly delay healing.

They say, Some recent studies suggest that ice—especially when used during the acute phase of an injury—reduces blood flow and can, therefore, end up delaying the healing process.
The conventional wisdom behind using ice on soft-tissue injuries was that doing so would reduce pain and swelling. But the body’s inflammatory response to an injury is a built-in mechanism to help the tissue heal.
There is debate on whether or not nonsteroidal anti-inflammatory drugs (NSAIDs) delay healing. Advice to avoid them is based on the idea that the natural phases of inflammation help repair damaged soft tissues and that using medications to reduce inflammation can be detrimental to that process.
The studies, though only in animal models, show delayed muscle regeneration, and that, when the muscle does regenerate, there is decreased strength and size in the first few weeks following injury.