Debunking the RICE Model of Soft Tissue Injuries

Updated: Oct 1

If you have never heard of the RICE acronym in reference to treatment of soft-tissue injuries, it stands for: Rest, Ice, Compress, and Elevate. This widely known acronym has been around for years, and although it has been extremely effective in the beginning stages of the injury, it has recently been shown to be non-effective or even detrimental to the long term management to soft-tissue injuries such as ankle sprains or a pulled hamstrings. For all of you athletes and active individuals, we will break down each letter of the RICE model and teach you how to more effectively manage your injuries and get you back to 100%.


Rest

Immediately following a soft tissue injury, rest is an important step for roughly 1-3 days. Unloading the injured body part will allow for minimized bleeding and reduction of re-aggravation. However, after those first couple of days, rest should be minimized to allow for the body to promote proper tissue quality and strength. This will allow for new healthy nutrients to get back into the tissue for maximal recovery. This concept explains why hard casts for broken bones are becoming much more rare, while braces, splints, and slings are more commonplace. These methods allow for a proper amount of immobilization while still allowing for tissue healing, prevention of muscular atrophy and tissue malformation. If an injury does heal correctly the first time around, scar tissue may develop with a major loss of movement requiring much more vigorous rehab and treatment. Avoid any activities and movements that increase pain during the first few days after an injury. After that timeframe, you have the green light to lightly increase your activity level as long as it is pain free . Always consult with your trusted physician after an injury to identify the severity and any complications that may limit recovery.

Ice

As much as ice has been recommended over the years, there is no high-quality evidence on the efficacy of ice for treating soft-tissue injuries. To make things tricky however, there is still a balance to be had between optimal soft tissue healing and sports performance. There are two main times that icing may still be indicated: to prevent rapid swelling within the first 48 hours of an injury, and to reduce the pain one may feel by effectively “numbing” the area. If you must “get back in the game” after an injury, icing will allow for the swelling to be minimized allow for optimal range of motion, and decrease the pain to a bearable level. As an athlete or a parent of an athlete, you must weigh the pros and cons between proper tissue recovery and the importance of the sporting event.


If the pain is still bearable after the first two days, ice should not be used unless with contrast therapy (alternating heat and ice, which is what we recommend at Comprehensive Chiropractic). The reason being is that ice slows the much needed blood flow to the area, stops new blood vessels from forming, and impedes the necessary inflammatory process. Inversely, within the first 48 hours of an injury, NEVER put heat on the damaged area.

Compression

Although we may have been tough on the first half of the RICE acronym, we believe the third letter “compression”is still spot on, and plays a crucial and beneficial role in injury management Any type of compression such as taping, bandages or a compression sock/sleeve will help reduce swelling and improve overall quality of movement, while decreasing pain. This is the one part of RICE that we actively promote and believe has very therapeutic benefits to injury recovery.

Elevation

We are neither for or against elevation of an injury, which is supposed to promote the excess fluid out of the extremity and back to the heart. If it seems to help in your case, go for it. If not, go ahead and avoid. There is no risk to either elevation or no elevation. So kick your feet up, relax, and enjoy a couple of days off if you please.

Injuries Need PEACE & LOVE


The British Journal of Sports Medicine agreed with our opinion that the RICE acronym needed to be update, and recently they came up with the new multi-word acronym PEACE & LOVE. This approach facilitates what we discussed earlier in this post with the addition of avoiding anti-inflammatories! There is actually two phases to the inflammatory process, the breakdown of damaged tissue, and then the build up of new tissue shortly after. Anti-inflammatories limit the bodies natural ability to re-build after an injury by inhibiting the second stage of the inflammatory process.

If you or someone you know has had a soft-tissue injury, we would love to help get you pain free and build a tailor made exercise program that is right for you and your goals. Set up your appointment today by calling Comprehensive Chiropractic & Sports Performance at 636-938-9310.


Reference:

  1. Dubois B, Esculier J. Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine 2020;54:72-73.

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