Over the years the acronym R.I.C.E has been used to describe what to do in for the management of an acute (early) injury. More recently the additional letter P has been added to the beginning of the acronym. Often following these guidelines can enable the injury to resolve and no further intervention is therefore required.

The aim of your self management is to minimise the amount of bleeding within the tissues and therefore limit the damage.

These guidelines have been written with reference to the Association of Chartered Physiotherapists in Sports Medication evidenced based document on the Management of Acute Injuries.

P is for PROTECTION

Protection of the injured limb / joint or muscle may not be required. However depending on the severity of the injury protection should be applied in the form of tape, bandages or splints during the early stages of the healing (at least up to day 3).

The protection used will varying depending on the severity and may range from crutches (for full non-weight bearing protection) to a splint (to allow gentle movement). Supports and splints should only be used under medical guidance.

It is important that the protection device used will still be comfortable if the injured area starts to swell.

R is for REST

Immediate rest for 24hours after the injury is recommended to prevent further tissue bleeding and damage. Mobilisation and massage are not recommended during this period.

The optimum period of rest is between one to five days depending on the severity of the injury. You should be guided by your pain as to how much rest you require.

I is for ICE

Ice should be applied to the area of your injury as soon as possible. The aim of applying ice is to cool the tissues and constrict the blood vessels which will help limit the tissue bleeding.

The most effective method of applying ice is to put crushed ice in a damp towel over the area of the injury; however ice cubes in a plastic bag or frozen gel packs can be used. Damp towels should always be applied directly to the skin before the ice to prevent an ‘ice burn’.

The most effective duration of application of ice is 20-30 minutes, applied every two waking hours, with a recommended maximum of 30minutes to avoid tissue damage.

The time that the ice is left on for may vary slightly depending on your amount of subcutaneous fat in the area. If the area has very little fat around it you are advised to limit the length of time that the ice is applied for to no more that 10minutes.

If your sensation (your ability to feel) is effected as a result of the injury it is advisable to seek further advice.

C is for COMPRESSION

Compression should be applied as soon as possible following injury as it will help to limit the bleeding and swelling. Compression can be achieved by the application of firm bandaging or tubular elasticated support.

Compression can be continued for the first 72 hours after injury, when NOT lying down.

It is important to keep an eye on the colour of the skin around the compression to ensure that the circulation is not being reduced (the skin should not be cold or pale).

E is for ELEVATION

Elevation of the injured part above the level of the heart as much as possible during the first 72 hours following injury. This will allow gravity to aid the drainage of tissue fluids.

If the injured area can be maintained in elevation, DO NOT APPLY COMPRESSION AT THE SAME TIME.

It is worth noting that Arnica Montana has been widely documented as a successful homoepathic remedy in the reduction of bruising.

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