214:
injuries. For the next step the step prior has to be completed. The first step in the sequence is inflammation. If you use ice to reduce inflammation, it is only going to slow the healing process because inflammation needs to be complete for the sequence to keep progressing. In a recent study, athletes were told to exercise so intensely that they developed severe muscle damage that caused extensive muscle soreness. Although cooling delayed swelling, it did not hasten recovery from this muscle damage.
147:
38:
128:
blood flow to the area is reduced, which reduces the swelling and pain associated with inflammation. The early stages of healing involve microscopic scaffolding that is built upon to repair an injury. These scaffolds are relatively weak until reinforced by later stages of healing. Early and aggressive movement could potentially disrupt the scaffolds, delaying healing or worsen an existing injury.
102:. The protocol was often used to treat sprains, strains, cuts, bruises, and other similar injuries. Ice has been used for injuries since at least the 1960s, in a case where a 12-year-old boy needed to have a limb reattached. The limb was preserved before surgery by using ice. As news of the successful operation spread, the use of ice to treat acute injuries became common.
110:
of healing. In fact, many components of the protocol have since been shown to impair or delay healing by inhibiting inflammation. Early rehabilitation is now the recommendation to promote healing. Ice, compression, and elevation may have roles in decreasing swelling and pain, but have not shown to help with healing an injury.
168:
The current research supports the role of ice in temporary pain relief, but there is little evidence supporting the use of ice to aid in healing, or even swelling reduction. Further research is needed to further understand how ice should be applied. At this time, due to the lack of evidence, there is
109:
in 1978. He withdrew his support of this regimen in 2014 after learning of the role of inflammation in the healing process. The implementation of RICE for soft tissue injuries as described by Dr. Mirkin is no longer recommended, as there is not enough research on the efficacy of RICE in the promotion
218:
Rest may play a role immediately after an injury, but the evidence supports early mobilization to promote healing. Due to the inhibitory effects of ice on mounting a proper inflammatory response, a protocol including extended applications of ice could delay the body's attempt at healing. While it is
127:
Rest refers to limiting the use of an injured area. It was once recommended to rest an injury for up to 2 days or until it was no longer painful to use. It was intended to reduce inflammation and to prevent further injury. Blood supply is an important component of inflammation. By resting an injury,
197:
Elevation refers to keeping an injury above the level of the heart, such as propping up a leg with pillows. The goal was to reduce swelling by using gravity to encourage blood return from the swollen area back to the heart. The reduction in swelling could improve pain by relieving pressure from the
235:
management of soft tissue injuries. There is also evidence that points towards using heat to treat acute and soft tissue injuries. As stated before, ice is only going to restrict blood flow, and in turn, slow the healing process. The use of heat will open up the blood vessels in the affected area.
213:
Coaches have used my 'RICE' guideline for decades, but now it appears that both ice and complete rest may delay healing, instead of helping. The reasoning for this lies within the natural healing process. When an injury is created the body has to go through a very specific sequence to heal said
169:
no consensus on the ideal temperature ranges, time frames, application methods, or patient populations when using ice on a soft tissue injury. Most studies use icing protocols of intermittent 10-20 minute applications, several times a day for the first few days following an injury.
181:, braces, or similar devices to apply pressure over a localized area to reduce swelling and stop bleeding. The increased pressure pushes fluids into the blood vessels to drain away from the area. The effects of compression on swelling reduction are temporary and gravity-dependent.
222:
Currently, the RICE protocol is no longer recommended and has given way to other protocols for treating soft tissue injuries. Most recently, in 2019 the mnemonic "PEACE & LOVE" was coined by Blaise Dubois. The PEACE component stands for protection, elevation, avoid
184:
Although studies have demonstrated the effects of compression on swelling, there is little evidence to support the use of compression to promote healing. When considering the use of compression, the evidence supports the use of elastic bandages with
113:
There are different variations of the protocol, which may emphasize additional protective actions. However, these variations similarly lack sufficient evidence to be broadly recommended. Examples include PRICE, POLICE, and PEACE & LOVE.
165:. However, adequate blood flow is essential in allowing cells and signals from our immune system to reach injured areas. By reducing the entry of these cells and signals to the injury, healing can be delayed, or possibly inhibited.
717:"The PRICE study (Protection Rest Ice Compression Elevation): design of a randomised controlled trial comparing standard versus cryokinetic ice applications in the management of acute ankle sprain [ISRCTN13903946]"
219:
unclear what the effects of elevation and compression are on the healing process, reduction of swelling is a transient effect and returns when the injury is returned to a lower, gravity-dependent position.
131:
Although rest may provide some benefit immediately after an injury, returning to movement early has been shown to be better at reducing pain and encouraging healing.
236:
This will help speed up the healing process as well as reduce the possibility of persistent stagnation in the affected area and reduce the risk of future re-injury.
161:
Ice refers to the application of cold objects to an injury, such as ice, an icepack, frozen vegetables, etc. It was meant to reduce swelling and inflammation by
231:
soft tissue injuries. The LOVE component stands for load, optimism, vascularization, and exercise. It guides the treatment for the sub-chronic and
254:"PEACE & LOVE" â Protection, Elevation, Avoid Anti-inflammatories, Compression, Education & Load, Optimism, Vascularization, Exercise
198:
area. The effects of elevation on swelling have been shown to be temporary, as swelling returns when the injured area is no longer elevated.
1407:
461:
1093:"Volume Decreases After Elevation and Intermittent Compression of Postacute Ankle Sprains Are Negated by Gravity-Dependent Positioning"
551:
1343:
87:
320:
1590:
1185:
289:
98:. It was thought that the reduction in pain and swelling that occurred as a result of decreased inflammation helped with
496:
186:
367:"What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?"
1473:
1544:
1251:
917:"The Use of Ice in the Treatment of Acute Soft-Tissue Injury: A Systematic Review of Randomized Controlled Trials"
421:
Bayer, Monika L.; Mackey, Abigail; Magnusson, S. Peter; Krogsgaard, Michael R.; KjÊr, Michael (18 February 2019).
1400:
1037:
Takagi, Ryo; Fujita, Naoto; Arakawa, Takamitsu; Kawada, Shigeo; Ishii, Naokata; Miki, Akinori (1 February 2011).
244:
Variations of the acronym are sometimes used to emphasize additional steps that should be taken. These include:
1141:
1230:
1539:
1338:
1575:
1549:
1585:
1580:
1518:
1393:
1235:
1223:
977:"Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture?"
1554:
1534:
1421:
1333:
264:
83:
1218:
1178:
516:
1364:
1276:
178:
20:
365:
van den
Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM (2012).
1374:
1281:
201:
However, at this time there is little evidence to support that elevation promotes healing.
75:
1039:"Influence of icing on muscle regeneration after crush injury to skeletal muscles in rats"
321:"Sports Medicine Advisor 2005.4: RICE: Rest, Ice, Compression, and Elevation for Injuries"
79:
8:
1266:
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1171:
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228:
209:
Dr. Gabe Mirkin has since recanted his support for the regimen. In 2015 he wrote:
162:
324:
1493:
789:
772:
644:
845:
1503:
1468:
1433:
1312:
1297:
1256:
878:
715:
Bleakley CM, O'Connor S, Tully MA, Rocke LG, Macauley DC, McDonough SM (2007).
993:
382:
1569:
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446:
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95:
70:
for the four elements of a treatment regimen that was once recommended for
1443:
269:
106:
364:
50:
1438:
251:"POLICE" â Protection, Optimal Loading, Ice, Compression, and Elevation
1513:
1463:
1317:
1194:
91:
1091:
Tsang, Kavin K. W.; Hertel, Jay; Denegar, Craig R. (December 2003).
877:
Wallace, Heather A.; Basehore, Brandon M.; Zito, Patrick M. (2022),
189:(IPC) to reduce swelling and pain, while improving range of motion.
1488:
1417:
1359:
64:
1453:
1261:
67:
37:
1478:
1448:
1302:
1142:"Sports Medicine Monday: The Efficacy of Ice on Acute Injuries"
714:
552:"The R.I.C.E Protocol is a MYTH: A Review and Recommendations"
550:
Scialoia, Domenic; Swartzendruber, Adam J. (30 October 2020).
420:
1163:
154:
Ice being applied to a leg propped on a pillow for elevation
1508:
248:"PRICE" â Protection, Rest, Ice, Compression, and Elevation
1036:
914:
771:
Dubois, Blaise; Esculier, Jean-Francois (3 August 2019).
227:, compression, and education. It guides the treatment of
462:"Why You Shouldn't Ice An Injury â the RICE Method Myth"
915:
Bleakley C, McDonough S, MacAuley D (1 January 2004).
549:
517:"Why Ice Delays Recovery | Dr. Gabe Mirkin on Health"
876:
1090:
628:"PRICE needs updating, should we call the POLICE?"
94:treatment rather than a cure and aimed to control
830:"Inflammation and the blood microvascular system"
773:"Soft-tissue injuries simply need PEACE and LOVE"
685:Ivins D (2006). "Acute ankle sprain: an update".
1567:
885:, Treasure Island (FL): StatPearls Publishing,
710:
708:
680:
678:
770:
423:"[Treatment of acute muscle injuries]"
360:
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1401:
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1415:
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675:
339:
1408:
1394:
1186:
1172:
834:Cold Spring Harbor Perspectives in Biology
827:
36:
1116:
1010:
992:
975:Wang, Zi-Ru; Ni, Guo-Xin (16 June 2021).
853:
788:
742:
732:
643:
459:
390:
828:Pober, JS; Sessa, WC (23 October 2014).
575:
177:Compression refers to wearing bandages,
145:
1344:Wilderness emergency medical technician
921:The American Journal of Sports Medicine
684:
1568:
974:
621:
619:
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1032:
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906:
766:
764:
762:
576:Tiemstra, Jeffrey D. (15 June 2012).
515:Mirkin, Dr Gabe (16 September 2015).
117:
42:Rest, Ice, Compression, and Elevation
1139:
571:
569:
545:
543:
541:
539:
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510:
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416:
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315:
313:
311:
309:
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1133:
625:
608:
290:Nonsteroidal anti-inflammatory drug
105:The mnemonic was introduced by Dr.
13:
1077:
1027:
963:
903:
777:British Journal of Sports Medicine
759:
632:British Journal of Sports Medicine
453:
204:
187:Intermittent Pneumatic Compression
14:
1602:
566:
530:
505:
407:
302:
1252:Automated external defibrillator
1055:10.1152/japplphysiol.01187.2010
981:World Journal of Clinical Cases
870:
821:
578:"Update on acute ankle sprains"
480:
172:
1:
1231:Cardiopulmonary resuscitation
1193:
1043:Journal of Applied Physiology
295:
239:
1339:Emergency medical technician
1097:Journal of Athletic Training
790:10.1136/bjsports-2019-101253
645:10.1136/bjsports-2011-090297
371:Journal of Athletic Training
192:
150:Ice & Elevate Leg Part 1
7:
846:10.1101/cshperspect.a016345
258:
10:
1607:
1591:Sports medicine procedures
1236:Emergency bleeding control
18:
1527:
1429:
1352:
1334:Certified first responder
1326:
1290:
1244:
1201:
994:10.12998/wjcc.v9.i17.4116
687:American Family Physician
582:American Family Physician
491:. Boston: Little, Brown.
383:10.4085/1062-6050-47.4.14
144:
47:
35:
30:
933:10.1177/0363546503260757
721:BMC Musculoskelet Disord
265:Cold compression therapy
734:10.1186/1471-2474-8-125
460:Wojciechowksi, Andrew.
122:
879:"Wound Healing Phases"
626:C M, Bleakley (2012).
216:
151:
134:
90:. It was considered a
1277:Nasopharyngeal airway
211:
149:
21:Rice (disambiguation)
1282:Oropharyngeal airway
489:Sports-medicine book
427:Ugeskrift for Laeger
327:on 11 September 2007
72:soft tissue injuries
19:For other uses, see
1375:Wilderness medicine
638:(4). BMJ: 220â221.
487:Mirkin, G. (1981).
225:anti-inflammatories
141:
1576:Medical treatments
1370:Good Samaritan law
1140:Thompson, Dakota.
285:Soft tissue injury
152:
139:
118:Primary four terms
1586:Mnemonic acronyms
1581:Medical mnemonics
1563:
1562:
1383:
1382:
1214:Airway management
1209:Abdominal thrusts
987:(17): 4116â4122.
588:(12): 1170â1176.
556:The Sport Journal
159:
158:
140:Ice and Elevation
58:
57:
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1410:
1403:
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450:
433:(8): V11180753.
418:
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404:
394:
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336:
334:
332:
323:. Archived from
317:
163:vasoconstriction
142:
138:
51:edit on Wikidata
40:
28:
27:
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1601:
1600:
1599:
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1494:RPM-30-2-Can Do
1425:
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693:(10): 1714â20.
683:
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205:Current support
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17:
16:Medical acronym
12:
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1545:First response
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1327:Certifications
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1257:Bag valve mask
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468:. Correct Toes
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1469:IS PATH WARM?
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1148:. MUSC Health
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