RICE (rest, ice, compression, and elevation) is one of the most important “first” treatments for many injuries. You may see “RICE” used in information about athletic injuries. Think “RICE” when you have strains, sprains, or contusions. RICE therapy should also be used for dislocations or bone fractures that don’t break the skin and may be ordered by your surgeon after certain kinds of surgery.
Stop using the injured part as soon as you realize that an injury has taken place and rest it for about 48 hours. Continued exercise or activity could cause further injury, increased pain, or a delay in healing or risk bleeding. Use crutches to avoid bearing weight on injuries of the foot, ankle, knee, or leg. Use splints for injuries of the hand, wrist, elbow, or arm. If you have to seek medical care, your doctor may immobilize the injury with a splint or cast.
Ice helps stop internal bleeding from injured blood vessels and capillaries. Sudden cold causes the small blood vessels to contract. This contraction decreases the amount of blood that can collect around the wound. The more blood that collects, the longer the healing time. The other purpose for applying ice for a short time is to prevent edema or swelling. The cold constricts the blood vessels thereby reducing the leakage of fluid and limiting the accumulation of fluid in the nearby body tissues. Reducing the swelling can relieve pain by reducing the pressure on nerves due to swelling.
Ice can be safely applied right away in many ways including ice bag, cold compress and chemical cold pack.
• Ice the injured area for about 20-30 minutes.
• Remove the ice to allow the skin to warm for 15 minutes.
• Reapply the ice.
• Repeat the icing and warming cycles for 3 hours. Follow the instructions below for compression and elevation. If pain and swelling persist after 3 hours call your doctor. You may need to change the icing schedule after the first 3 hours. Regular ice treatment is often discontinued after 24 to 48 hours. At that point, heat is sometimes more comfortable—but don’t use heat in the first 24 hours. You can alternate 5 minute of heat with 5 minutes of ice.
• For injuries to small areas, such as a finger, toe, foot, or wrist, immerse the injured area for 15 to 30 minutes in a bucket of ice water. Keep adding ice cubes to keep the water cold.
• For injuries to larger areas, use ice packs. Don’t place the ice directly on the skin. Before applying the ice, place a towel, cloth, or one or two layers of an elasticized compression bandage (ACE bandage) on the skin to be iced. To make an ice pack, put ice chips or ice cubes in a plastic bag or wrap them in a thin towel. Place the ice pack over the covered skin at the injury. The pack may sit directly on the injured area. You can also wrap the ice pack in an elastic bandage to keep the ice in place.
Compression decreases swelling by slowing bleeding and limiting the accumulation of blood and plasma near the injured site. Without compression, fluid from adjacent normal tissue seeps into the injured area. The more blood and fluid that accumulates at the injury, the longer it takes the injury to heal. To safely apply compression to an injury:
• Use an elasticized bandage (Ace bandage) for compression, if possible. If you don’t have an elastic bandage, any kind of cloth will work for a short time.
• Wrap the injured part firmly, wrapping over the ice. Begin wrapping below the injury site and continue wrapping above the injury site.
• Be careful not to wrap the bandage or cloth so tightly that the blood supply is impaired. Signs of an impaired blood supply include pain, numbness, cramping, and blue or grayish-colored nails. If you see signs or have symptoms that the bandage is too tight, remove the compression bandage immediately. Leave the bandage off until all signs of impaired blood circulation have gone away. Then rewrap the injured area less tightly.
Elevating the injured part at or above the level of your heart is another way to decrease swelling and pain at the injury site. Elevate the iced, compressed area in whatever way is most convenient. Prop an injured leg on a solid object or pillows. Elevate an injured arm by lying down and placing pillows under the arm or on the chest with the arm folded across. You can elevate the upper body, say for shoulder injury, by sitting propped up with pillows or by putting blocks under the legs a the head of your bed.