To RICE or not to RICE?

What is best practice for optimising tissue healing?

The RICE (Rest, Ice, Compression, Elevation) protocol has been the preferred method for acute injury management since its inception. Coined by Dr. Gabe Mirkin, these guidelines provided recommendations for accelerating the recovery process and reducing inflammation. This process was updated to PRICE (Protection, Rest, Ice, Compression, Elevation), then POLICE (Protection, Optimum Loading, Ice application, Compression, Elevation).

The purpose of these protocols was to provide early treatment for musculoskeletal injuries. Early intervention is the best form of management to ensure that athletes are receiving appropriate care. However, we need to make sure that our management strategies are working in the individuals best interest.

After an injury, larger than normal amounts of blood and fluid will typically flood to the area, which will create an increase in swelling and pain while reducing joint range of motion. In this situation, individuals have typically been asked to rest and ice initially to manage these symptoms. Two concerns have been noted with this approach:

1. There is a lack of evidence that ice immediately post injury can improve outcomes. More recent research has brought to light that ice may impede on the usual healing process.
2. Rest is often taken too far. Some individuals will opt for a longer rest period when they could return to gentle exercises and basic movement patterns. Too much rest can lead to loss of muscle strength and flexibility.

These terms are still used very often at different levels of sport and allied health context. However, these are not the most updated guidelines for acute injury management. The 2019 update now suggests best practice is PEACE & LOVE.

PEACE

Protection: Avoid activities and movements that increase pain during the first 1 – 3 days post injury.

Elevation: Elevate the injured limb higher than the heart as often as possible.

Avoid Anti-Inflammatories: Avoid taking anti-inflammatories as they reduce tissue healing. Avoid icing.

Compression: Use elastic bondage or taping to reduce welling.

Education: Your body knows best. Avoid unnecessary passive treatments and medical investigations, and let nature play its role.

LOVE

Load: Let pain guide your gradual return to normal activities. Your body will tell you when it’s safe to increase load.

Optimism: Condition your brain for optimal recovery by being confident and positive.

Vascularisation: Choose pain-free cardiovascular activities to increase blood flow to repairing tissues.

Exercise: Restore mobility, strength and proprioception by adopting an active approach to recovery.

The aim of the new recovery protocols is to consider the individual as a whole. It encompasses rehabilitation as a continuum from immediate care (PEACE) to continuing management (LOVE). This will provide the individuals with the best opportunity for recovery post injury.

Please note, these are general guidelines. Post acute injury, please make sure that you consult with a healthcare professional to assist with your specific rehabilitation process.