If you’ve been unlucky enough to suffer from an acute musculoskeletal injury, following the PRICE or RICE principle has been a common way to manage any pain, inflammation and swelling. PRICE stands for: Protection, Rest, Ice, Compression and Elevation whilst RICE stands for Rest, Ice, Compression and Elevation. Both the PRICE and RICE principles have been advocated for a long time to help treat an injury within the first 72 hours. However, recent research has started to undermine both principles, particularly with regard to the ‘rest’ and ‘ice’ part.
If you’ve injured yourself then aim to protect yourself and the injured part. As soon as the injury occurs, make sure you’re not at risk from any other injury occurring. For example, if the injury occurs playing football on a sports field, stop the game until you’ve been removed from the field. After this, protect the injured part of you – this doesn’t however mean do nothing at all….
Originally, the advice was to absolutely rest an injury and to pretty much stop moving all together. However, you need to forget the idea of complete rest. If you rest an injured area entirely, this rest will fail to stimulate tissue repair which is critical for tissue healing. As you move, muscle contractions around lymphatic vessels clear waste and help to increase blood circulation to damaged tissues. This, in turn, encourages formation and laydown of new collagen and helps to boost the remodelling phase of the tissue healing process. However the balance between rest and activity is important. You don’t want to completely overload an already overloaded and injured area but applying an appropriate load can help to stimulate the metabolic processes of repair. Gentle movement within what you’re able to cope with is absolutely fine.
For example, we’re not suggesting that if you have a compound femoral fracture that you start to walk about on it if you’re unable to weight bear. But simply drawing the alphabet with your toes and ankle if you have an ankle sprain will provide gentle and active movement. Give your body time to heal and allow sufficient time for rehabilitation.
As part of the PRICE or RICE protocol, cold therapy was very much advocated within the first 48-72 hours post injury in order to help reduce localised bleeding, swelling, pain and inflammation. Today, people still believe that this is exactly what ice is going to do and continue to grab bags of frozen peas and trays of ice cubes. However, current research now indicates that ice can slow metabolic processes and nerve conduction velocity and may in fact impede the inflammatory process and therefore tissue repair. Whilst ice can be used to successfully numb an injured area and therefore reduce pain, it can unfortunately affect your body’s natural tissue healing response and is no longer completely supported post injury.
Check out our forthcoming blog ‘Stepping Out of the Ice Age’ which addresses just this. Aim to avoid ice entirely if you can. However, if the pain is too much and you have to use ice, aim to apply ice for only 15-20 minutes with at least an hour in between.
Compression of the swollen area has been shown to help reduce any swelling. A stretchy bandage or tubular bandage will suffice. Always make sure the bandage is wrapped firmly around the injured part but make sure that it isn’t too tight. Remove or loosen any bandages if you start to feel any pins and needles or numbness or if you start to notice any changes in colour in the affected area.
Elevate the injured part as much as possible in the early stages post injury. Ensure that you elevate the area above the level of the heart to help reduce the flow of blood to the area to help reduce swelling and inflammation. Make sure that when you elevate any body part it’s comfortable and doesn’t cause you any excessive pain.
PRICE and RICE:
PRICE and RICE principles are commonly suggested to manage acute injuries but have not been fully validated in adequately randomised controlled trials. Commonly, they have formed the best known principles for managing an acute injury. However, both principles are now somewhat outdated in acute injury management as both rest and icing are no longer fully supported by the research. In order to expedite your return to sport or activity, active recovery within what you are able to do is now promoted. It’s often useful to seek the advice of a physio or health professional to help manage any injuries correctly.