Rice, price

Probably you are thinking that the title of this post doesn’t seem to have anything to do with Physical Therapy. Well, with the words RICE and PRICE I could make up a story about some supermarket business and the amazing sales they have for this season, but, first of all, it doesn’t sound entertaining at all and, secondly, this is not the correct blog for this. However, notice that a police case kind of thing will be part of this story in a future chapter to make the story a bit more interesting.

The reality is that these two words are all about Physical Therapy, actually, they are acronyms related to the acute injury management protocol.

If you suffer an injury such as a sprain, strain, contusion, muscle pull or tear, this protocol can prevent complications and help you heal faster. So, if injured, RICE; if injured PRICE or (in a future post) if injured POLICE.

RICE was the first one and, probably, the best known of the three of them if you are a sportsman. After RICE, PRICE came to improve the protocol a bit, and lastly POLICE, the definitive one (final) so far.

Let’s start with the food, the old fashioned RICE:

These are the first 4 things you were supposed to do for the first 48-72 hours after injury. I am going to explain to you a bit more about this and then why I wrote above “ you were supposed to do …”

R for rest:

Rest was thought to be vital to protect the injured muscle, tendon, ligament and so on. “Your injury needs time to heal”, your therapist used to say. “If you don’t rest, you will have chronic damage” was stated by your doctor. Crutches here, crutches there, crutches everywhere! And sometimes even a cast! Health professionals used to think that if you didn’t rest, your injury couldn’t heal properly and if this happened you might not be able to play your sport at the same level as previously. “Don’t move it at all until you don’t feel any pain”. All this has changed considerably, as I will explain later on, and that’s why I wrote ” you were supposed to do…” in the previous paragraph.

I for ice:

By applying ice to the injury you will reduce pain and swelling. There are many opinions about ice and its application and still controversy about this subject, as research behind the application of ice is not conclusive and there is not high quality evidence about whether ice is good or not and how to apply it. Have a look at this study by Domhnall C. Mac Auley that talks about the effectiveness of ice on acute injuries. Also, ice is used by many people and recommended by health professionals, research is not everything, experience is very important as well.

The most common option of ice application and probably the best is the ice pack. Frozen peas, instead of an ice pack, is also a good option.

How to apply it?  There are many different ways. One of them is to apply the ice pack for 20 mins  each hour for the first few hours then 3-4 times daily over the next 48hrs. Another way is to apply ice for 10 mins then remove it for 10 mins and apply it again for 10 mins, repeating this every 1-2 hours for a 48–72 hour period (this method of applying ice is thought to be better than the previous one, as the study linked previously suggests).  These methods are just two of the many possible ways to apply ice. After 72hrs, in my opinion the best way is doing  “hot/cold immersion therapy” or contrast bath (find more about contrast bath in the post: treatment of Achilles tendinitis).

Be careful when applying ice:

  1. Don’t ice over a numb area.
  2. Make sure that a light barrier is placed between your skin and the ice pack to prevent ice burn.
  3. Don’t apply ice for less than 10 mins (you will find no results) or more than 30 mins (risk of burn).

C for compression:

Research behind compression is not extensive, as with ice. Compression seems to help to limit and reduce swelling, helping the healing process. This study by Mark A. Merrick y col. talks about the effectiveness of compression combined with ice.

Although some swelling is inevitable, too much swelling might mean loss of function, more pain and poorer blood flow. Compression serves to minimize the injured area.
You will need a bandage. Make sure that the bandage is not too tight, as it could lead to ischaemia (restriction in blood supply to the tissues). The area should feel compressed but not uncomfortable or painful. Elastic bandage is usually a good choice, although semi-rigid support seems to be even better according to this research by Ivins D.(notice that this study is only about ankle sprains).
You don’t need to have the bandage on the whole day, remove it when sleeping because it might cause harm without you realising and also swelling is usually well controlled when we are lying down.

E for elevation: 

Elevation aims to reduce pain and swelling by increasing venous return of blood to the systemic circulation. Elevating the injury above your heart level will help to control the swelling. This will also result in less pain.

You can combine it with gentle exercises to improve circulation such as moving the ankle up and down or doing circular ankle movements. Although, it will depend on the injury you have, as sometimes these exercises are not recommended ( for example, ankle fracture).

Ok, we are done for now. I told you at the beginning of this post that this is what you were supposed to do, but it changed and another protocol came to join our sporting life. Add a “P” and RICE becomes PRICE, a simple 5 step protocol to manage acute injuries.

What is that P” about?

P for protection:

Protect any injury from further damage. Stop playing and use protection, as for example, ankle brace to limit range of motion of your ankle or crutches to take the weight off. What you are doing by this is to allow the injury to heal.

Other acronyms that haven’t been very successful are RICER and PRINCE, among others.

RICER for rest, ice, compression, elevation and rehabilitation. I think that the “R” added was a good step forward, although this acronym didn’t become very popular.

PRINCE for protection, rest, ice, NSAIDs (non- steroidal anti-inflammatory drugs), compression and elevation. I am not really keen on drugs, so this is not my favourite one.

And recently the new one came to stay with us. For how long? No one knows the answer. Welcome to the acronym’s world for acute injury management, Mr POLICE.

Notice that sometimes you will need to visit a health professional if your injury is serious or you can’t control the symptoms and signs by yourself. Never forget this sentence ” if in doubt, consult a professional”.

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If you have any questions, contact me on The Physical TherapyPhysiotherapy Clinic in Soton.
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6 Responses to Acute injury management – RICE and PRICE

  1. Emily Seto says:

    I love these acronyms!!! I am VERY familiar with RICE, having had ITBS, piriformis syndrome, plantar fasciitis, and several other types of nagging injuries that I’ve spent a lot of time rehabbing. But the RICER and PRINCE make great sense, as well!

  2. ThePhysicalTherapy says:

    Hi Emily, you have had all the bad injuries. Notice that if you get injured again, the acronym to follow now is POLICE which I will post next week. I hope you don’t need to use it soon!! Thank you for your comment.

  3. I’d heard of RICE and PRICE, but PRINCE, hadn’t heard that term, I like it! I am going through a really bad achilles injury that has had me out for 10 months. It wasn’t until the Specialist recommended the things that you list in the PRINCE method that I was able to finally get some help! I’m hoping with diligence on PT on my part and with the PT that I might even get to start running again in another month or so:) Love your blog, I’m going to add this one to one of my favorites so I can come back to it and share it with my running friends when they are going through injuries/prevention!! Thanks!

    • ThePhysicalTherapy says:

      Thank you very much, I really appreciate your words. I am pretty sure that with a bit of patience and sensibleness you will be back running soon. There are something like 10 acronyms about this subject, actually I will post another article about POLICE later this week. This comment has made my day 🙂 I will be happy to help you and your friends whenever you need some advice, through email, facebook or twitter (in case you don’t want to do it through my blog). Many thanks again and recover soon!!

  4. beverly holcomb says:

    I am taking a first aide class. For extra credit, we are to find out what the old acronym for R.I.C.E. was and why they changed it. All I can find is that it used to be Rest, Ice, Compression, Elevation and, now, it is Rest, Immobilization, Cold, and Elevation. Do you know an older acronym for R.I.C.E.?

    • Jorge Rodríguez says:

      Hello Beverly. I don´t have an answer to your question, sorry. But aren´t you sure that they didn´t mean why they changed RICE for another one like PRICE or POLICE? Regards

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