Applying RICE to Acute Injuries

Acute Injuries

A strain to a muscle or tendon is the most common type of acute injury. It occurs when tissue fibres become torn or damaged and causes bleeding and swelling due to overloading or stretching.

Another common injury is a joint sprain, where a ligament that supports the joint is torn. This occurs if a joint is forced beyond its normal range. There will be considerable swelling and bruising, pain and dysfunction with any attempt to put movement or pressure through the joint.

Depending on the severity of the injury, during the first 24-48 hours the RICE principles should be used.

• Rest Immediate rest from any movement or load-bearing enables the fibres to begin to knit together quickly before any more damage is done. Movement will continue to open and aggravate the tear and cause more bleeding.

• Ice Ice slows down blood circulation and so reduces the amount of bleeding and swelling in the tissues. Ice should be wrapped in a cloth to prevent skin burning. Ten minutes is a good guide to the length of time ice should be applied for. The body will send more blood to the area to prevent the skin from freezing if ice is left on too long, reversing the effects. Ice also chills and numbs the pain receptors. By reducing the pain sensation it also reduces the protective spasm around the injury and the area becomes more relaxed. This allows the swelling to dissipate more quickly.

• Compression The pressure of a compression bandage, compresses the blood vessels so preventing blood from escaping through the open ends of the torn fibres.

• Elevation Elevation of the injured area allows gravity to assist the removal of swelling from the area and so aids recovery.

Massage and Acute Injuries

Massage should not be applied directly to an acute injury as the movement it will create
within the tissues can re-open the tears in the fibres. And, by increasing the circulation, it
will also encourage more bleeding. General massage techniques away from the injury
can be beneficial.



Post-Acute Treatment

When the signs of inflammation have gone and swelling, heat and redness are reduced
(usually after about 48-72 hours) the MICE procedure can be followed.

• Mobilization This is an active movement by the client of the injured part, through its full pain-free range. This works the muscles and prevents atrophy. After 3-4 days the client should be encouraged to try and gently start to actively increase this range, within pain tolerance.

• Ice Should be continued for about a week, especially if discomfort following mobility exercise.
  

Heat can be applied after 5 days providing inflammation has stopped. Heat helps promote
healing by stimulating the circulation. Contrast baths also stimulate the circulation, and the
contrasting sensory nerve stimulation can be highly relaxing and can release muscle
tension. Use hot and cold alternatively for one minute at a time.

• Compression Can be continued for a few days until condition improves.

• Elevation Can be continued until all swelling has gone.

Massage

Gentle, superficial stroking techniques can be applied directly to strains or sprains after
about three days. Deeper stroking and light friction can be started after about five days.
Treatment should not cause too much pain, otherwise it may caused further damage. The
aim of massage at this stage is to:

• Reduce swelling.
• Stimulate circulation (promote healing).
• Prevent excessive scar tissue forming.
• Prevent, or break down, adhesions.

Pre-Event & Post Event Massage

PRE-Event Massage

Pre-event massage can be performed from two days to two minutes before an event. Two days before an event, the massage can be deep, thorough and relaxing. Specific problem areas may take a day or two to recover from, so should therefore not be given too close to the event (no closer than five days). Just prior to the event it may be necessary to relax and calm the athlete down a little with rocking and shacking movements rather than working deeply into the tissues, as the muscles should not be relaxed too much. For someone who is well trained and properly prepared for his event the effect of the massage should be more psychological than physical. Treatment may be given through clothing.

Slow techniques will have a relaxing and calming effect, working vigorously will be stimulating.

Massage should not be a substitute for a proper warm-up.


POST-Event Massage

Massage after an event can be an adequate substitute for a warm-down, as it can achieve much the same effect by removing muscle waste and stretching the tissues. Superficial stroking should be used first to help identify any acute problems. Ice can be placed on an affected area while massage is applied around and away from it. The ice can be removed after a few minutes and light massage applied over the injured area to dissipate swelling, the ice can then be re-applied. Although massage is believed to be contra-indicated in the acute stage, the method of ice/massage/ice so soon after the injury can be remarkably effective. Gentle passive stretching of the muscles can be carried out at the end.