Update on the R.I.C.E Principle
P.O.L.I.C.E. –Protection, Optimal Loading, Ice, Compression and Elevation
It might be time to revise the old acronym RICE, and PRICE which have been used as the guide for management of acute soft tissue injuries for many years. If we experienced any sprains, strains or tears, we would be advised to follow the RICE principle. Rest, Ice, Compression, Elevation. But according to recent research, it looks like we need to be changing a few of these components.
Rest and its detrimental effects.
As much as it is important that we have a short period of unloading the injured area immediately after the injury, it seems that people can take the advice of resting a little bit too literally. The resting or de-loading phase of an injury should be restricted to short periods immediately after the trauma, roughly the first 24 hours. This will allow an optimal amount of inflammation to occur to provide the right amount of local blood flow to stimulate healing. It is more important to protect further damage to the area and to minimise levels of inflammation which may hinder the healing process.
It is worth noting that in the natural world, animals who get injured do not go home and put their foot up for a few days or weeks in a row. Immediate introduction of natural levels of gradual loading which allows the animal to self-regulate their mechanical loading as able allows optimum stimulation of healing.
In our society we have been able to create an artificial environment which can allow rest periods or complete unloading for days or weeks at a time. However, more and more studies are demonstrating the adverse effects of rest, or offloading the injured area, not just locally at the site of the injury, but also in the surrounding joints, muscles, tendons, ligaments, and even bones.
It is important to note that the body constantly responds to stimuli: LOAD or NO LOAD. For the body, there is no absence of stimuli, it is not a vacuum. The muscles respond to having NO LOAD by atrophy, decreasing muscle size. Muscles have been shown to have no evidence of regeneration until it is mobilised. Ligaments and tendons become stiff, and bones decrease density. Weight bearing bones in particular are very sensitive to the absence of mechanical load.
Ice, Compression and Elevation
There is limited evidence to support the effect of ice, compression and elevation on an acute soft tissue injury. Generally, the results are inconclusive. Some studies have shown positive results for the analgesic effect of ice. There is some evidence to support minimising swelling and local bleeding in the injured site as this can assist in minimising the size of the haematoma. This in turn allows healing of the region by connective tissue being able to bridge the gap in the damaged area more effectively.
Optimal environment is targeted at facilitating healing, rather than preventing inflammation. Many studies have been able to show that early loading, at an optimal level is what determines the ideal healing and regeneration of damaged tissue.
Finding the right balance can be a challenge. Doing too much can be detrimental due to re-injury, or further damage, increasing bleeding Doing too little can also be detrimental as our body responds to no load as a negative as described above. The old saying “use it or lose it“ is correct in this instance.
Optimal loading while introduced early, should be “little, but often”. Loads also need to be applied which will mimic the tissues’ normal stresses. This includes, compressive loads, tensile loads, traction loads, tactile and multi-directional/combined loads. We also need to introduce different volumes, intensity and velocity of loads that are appropriate to stimulate collagen formation that can withstand different stresses in the future.
Different tissue responds in a variety of ways when a stimulus is provided, and we need to keep this in mind when considering a rehabilitation plan for a soft tissue injury. For example; compressive and plyometric loads may be appropriate for rebuilding bone density, but we need to be mindful of the exercises that we prescribe as they may injure or further injure a weak tendon.
As always this advice is very general in nature and may not be appropriate for all injuries and all people. For individualised advice and thorough assessment of your injury, do not hesitate to contact us on (07) 40513252 or BOOK ONLINE!