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R.I.C.E. Treatment for Injuries

Posted by: BA

I created this article for an admin on another board, though I felt that fellow members on here would find it useful. Working in tandem with a highly qualified physio who works with a professional rugby team, what I''ve posted below goes into quite abit of detail so as to provide you with additional information on why you should perform certain tasks.

R - Rest
I - Ice
C - Compression
E - Elevation

What all professional minded athletes should do when they suffer injuries, particularly to their joints. I''ll use an example to make it more relevant;

Rest: You are running/ playing sports and you sprain your ankle. Immediately you have overstretched or (partially) torn some of the ligaments in your ankle (usually lateral ligaments). The first thing you do is make sure that you do not suffer any more damage to the ankle by putting unnecessary strain/ pressure on it. If you have to be carried off the field or supported by 1-2 fellow players/ coaches then so be it - think damage limitation.

Ice: Within minutes of the injury occurring, additional symptoms (aside from tenderness/ pain) will include discolouration and swelling. Already, the body is responding to the injury through a number of reactions; inflammatory response/ fluid accumulation - heat from the injury is causing additional body fluids (plasma/ extracellular fluid) and blood (from the torn capillaries in the ligaments you ruptured/ stretched) to accumulate in the injured area. This results in further cellular death as the distance between undamaged capillaries and undamaged cells has increased due to the fluid accumulation; Result - oxygen deprivation of the (partially) damaged cells, which results in additional cell death. You must apply ice to the injury within no more than 20 minutes from when the injury occurred - swelling can only be reduced/ prevented, not reversed. The sooner you can apply the ice the less plasma you stop "leaking" out of the capillaries and causing fluid accumulation. Failure to do so will result in the ice having no more than an analgesic (pain killing) effect on the injured area.

*Tip: A polythene bag, half a dozen ice cubes and 2-300ml of cold water will make the perfect ice bag (remember to tie the neck of the bag before applying). It is essential that you add water to the polythene bag so that the surface area of the injury is completely enshrouded in cold (if you can crush the ice it''s just as good).

The ice will also promote vasoconstriction (narrowing of the blood vessels) of the surrounding capillaries to as to reduce circulation to the injured area, resulting in further unnecessary swelling/ bruising.

An ice bag should be applied for 20 minutes every 2 hours, as long as 24-72 hours from when the injury occurred. If possible, this should be done through out the night aswell, as our circulation obviously doesn''t cease when we sleep.

Compression: When not iced, the injured area should be properly wrapped using a compression/ support bandage, or if the injury is severe, using a prophylactic ankle brace. Not only will this also reduce swelling of the injured area, but it will also restrict unnecessary movement of the ankle joint - remember, try to prevent unnecessary strain on the injured ankle, and prevent newly formed blood clots from being broken up (result, more bleeding) due to joint movement. The bandage/ brace provides both psychologic and physical support/ protection to the injured area.

Elevation: It is important that you elevate the injured area/ limb above the level of your heart to prevent additional swelling of the injured joint - think hydrostatic pressure; if you "stand" on the injured area, or remain upright the pressure from way up in your heart will result in additional plasma/ extracellular fluid being "forced" from the capillaries in your ankle, meaning a greater amount of swelling/ fluid retention in the joint area; remember, as I mentioned before, "swelling" results in additional cell death thus slower rates of recovery.

Most of you are healthy *young* individuals, though their are a number of contraindications that may prevent you from carrying out all aspects of the RICE procedure, particularly the Ice section. These are (off the top of my head); allergy to the cold, heart/ circulatory problems, diabetes (due to circulatory problems sometimes associated with this condition), skin allergy, serious burns to the injured area, deep vein thrombosis, age (old people can suffer from shock due to significant changes in temperature). Always make sure that there is a medium between the ice and your skin, such as the polythene bag or a towel, as an ice burn can be just as serious as wet (steam/ water) or dry burns.

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