R.I.C.E. Treatment for Acute Musculoskeletal Injury

Self-Care to Reduce Pain and Swelling With Soft Tissue Injuries

Applying ice pack to injured ankle
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The R.I.C.E. treatment is recommended by health professionals for the early treatment of bone injury or acute soft tissue injuries such as a sprain or strain. It can be helpful for sports injuries, closed fractures, and degenerative joint problems.

The acronym R.I.C.E. stands for:

  • Rest
  • Ice
  • Compression
  • Elevation

The primary goal of R.I.C.E. is to bring pain and swelling under control as quickly as possible.

It should be started as soon as pain and swelling occur and used until there is healing of minor injuries or until another treatment has been initiated for more complex problems. Here are the basics of R.I.C.E.

Rest

Rest is needed for the healing of injured tissue. Without rest, movement and weight bearing can continue to aggravate an injury and cause increased inflammation and swelling. You should initially reduce using or stop using the injured area for 48 hours. If you have a leg injury, you may need to stay off of it completely (i.e., non-weight bearing). You may need to use assistive devices or mobility aids to keep off of the injured joint or limb. 

Ice

Ice is useful for reducing pain and inflammation associated with an acute injury. Icing is most effective if done the first couple of days after the injury has occurred. You can apply ice for 20 minutes at a time and as frequently as every hour.

If you prefer, apply it four to eight times a day.

You can use a cold gel pack or a plastic bag filled with ice, but do not apply a bag of ice directly to the skin. Instead, wrap the bag of ice in a towel or make sure there is some layer of material between the ice and your skin. Often, gel packs or cold packs sold for this purpose have a cover provided.

Don't leave the ice on your injury for more than 20 minutes at a time or you could damage your skin. After you remove the ice pack, give your skin time enough to get warm before icing it again.

Compression

Compression of an injured or painful ankle, knee, or wrist helps to reduce the swelling. Elastic bandages, such as ACE wraps, are most commonly used. Special boots, air casts, and splints can serve a dual purpose of compression and support. Your doctor should make a recommendation and discuss your options. Be sure not to apply excessive compression which would act as a tourniquet and interfere with your blood circulation. If you feel throbbing, it's probably on too tight, and you should take off the wrap and put it back on a little looser.

Elevation

Elevate the injured part of the body (e.g., leg or ankle) above heart level. This provides a downward path for draining fluid back to the heart, which reduces swelling and pain. Try to elevate the entire limb six to 10 inches above the heart so there is a complete downhill path. Lay down and use a pillow to help elevate the injured limb.

When to Seek Medical Treatment

Too often, people with an acute injury do nothing with the hope that it will go away without any intervention.

Many common acute injuries can be helped by R.I.C.E., especially when combined with over-the-counter pain relievers. But if your pain and swelling don't begin to go down after 48 hours, you should see your doctor.

Get professional treatment immediately if any injury is severe. A severe injury implies that there is an obvious fracture, dislocation of a joint, prolonged swelling, or prolonged or severe pain. Serious injuries may require more intensive treatment and possibly surgery.

A Word From Verywell

Sprains and strains can happen to anyone, whether on the playing field or simply when making a wrong move at home.

Bringing pain, swelling, and inflammation under control as soon as possible is the optimal plan. It's smart to stock an ice bag and an ACE bandage as part of your emergency first aid supplies. You might even keep a cold gel pack in the freezer to have ready.

Sources:

Approach to Sports Injuries. Merck Manual. http://www.merckmanuals.com/professional/injuries-poisoning/sports-injury/approach-to-sports-injuries.

Preventing Musculoskeletal Sports Injuries in Youth: A Guide for Parents. NIAMS. https://www.niams.nih.gov/Health_Info/Sports_Injuries/child_sports_injuries.asp.

RICE Therapy. Family Practice Notebook. http://www.fpnotebook.com/Sports/Pharm/RcThrpy.htm.

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