Related Terms

• Achilles tendon, air casts, ankle, anterior cruciate ligament (ACL), anti-inflammatory, bandage, brace, bruises, cane, cast, cold, compression, contusions, crutches, elevation, extensor, ice, ice bath, joint, ligament, lumbar, medial collateral ligament (MCL), metatarsophalangeal, mobility, plantaris, rest, RICE, RICE treatment, splint, sprains, strains, stretching, swelling, tendon, tennis, thumb, turf toe, warm-up, whiplash.

Background

• R.I.C.E. treatment is an acronym for: rest, ice, compression, and elevation. It is commonly used to speed up healing and reduce pain and swelling caused by mild-to-moderate injuries, such as sprains, strains, and bruises. More severe injuries may require medication and/or surgery.

• Sprains refer to tearing or stretching of the ligaments that connect joints to bones. Strains are tears or stretches to the muscle tendons. These injuries often occur during high-impact or high-intensity sports, such as cheerleading, dancing, skiing, wrestling, baseball, and basketball. Bruising occurs when blood vessels break, spilling blood into the tissues and turning the tissues a purplish or other dark color.

• R.I.C.E. treatment is a commonly used and generally accepted treatment by medical professionals, coaches, athletic trainers, and athletes. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), American Academy of Family Physicians, National Athletic Trainers' Association, American Orthopaedic Society for Sports Medicine (AOSSM), and American Academy of Orthopaedic Surgeons recommend this treatment for mild-to-moderate sprains and strains that do not require medical attention.

• Some patients may administer R.I.C.E. treatment without medical supervision, or they may seek medical advice on how the treatment is carried out.

• With proper treatment, healing typically starts with a reduction in pain and swelling between 24-72 hours after injury. Bruising decreases, and range of motion increases in 7-14 days for minor sprains and strains, according to the American College of Sports Medicine (ACSM). R.I.C.E. treatment begins immediately after injury, the time that is the best indicator of recovery, according to the ACSM.

• Many injured athletes return to their sport activities when they are only 70% recovered, which may increase the risk of reinjury or additional injuries, according to the AOSSM.

• The ankle is the most common site for sprains. More than 25,000 people in the United States sprain their ankles daily, according to the NIAMS. Lower-body strains and sprains were the most commonly reported injuries in 2004-2007, according to the U.S. Centers for Disease Control and Prevention (CDC). Ankles rolling inward comprise about 80% of sprains, according to the ACSM.

• Injuries to the hands and arms make up 30-40% of all injuries, and the thumb joint is the most likely joint of the upper extremities to be affected by injury, according to the ACSM.

• Some studies suggest that as many as 40% of ankle sprains are improperly treated. Organizations like the ACSM recommend public education of proper sprain and strain treatments.

Technique

• General: R.I.C.E. (rest, ice, compression, and elevation) treatment for mild-to-moderate sprains, strains, and bruises involves resting, icing, properly wrapping or otherwise compressing, and elevating the injured body part.

• The four components of R.I.C.E. reduce pain and swelling and speed the healing process. Swelling may prevent oxygen from reaching tissues and cause cellular damage. R.I.C.E. treatment may be followed by rehabilitation to increase mobility and functionality of the affected area.

• Diagnosis: A doctor or other qualified medical professional may assess the severity of the injury and recommend R.I.C.E. treatment in cases of mild-to-moderate injury. This treatment does not generally require medical supervision. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) recommends that any person who is uncertain about the seriousness of his or her injury consult a medical professional.

• Application: The treatment begins immediately after the injury and lasts for 24-48 hours. It may also be accompanied by pain medication or nonsteroidal anti-inflammatory drugs (such as ibuprofen).

• Rest: Physical activity may worsen the injury. Resting the injured area allows the area time to heal and is therefore the first part of R.I.C.E. treatment. Resting involves not using and/or putting weight on that part of the body. This includes avoiding sports activities and certain daily living activities. The patient may require bed rest or need to refrain from using his or her hands or feet to properly rest the injured area. In the case of mild injury, the patient may return to normal activity in as soon as one day, according to the American Academy of Family Physicians (AAFP). Some patients may need to wear an immobilizing device like a splint or brace for several weeks.

• Canes and crutches: If the injured area is part of the leg or foot, it may be impossible for the patient to stay off his or her feet for the prescribed 24-48 hours. Canes and crutches (either one or two) may assist the patient by allowing him or her to walk without placing weight on the affected area.

• Canes may assist patients who are able to put some, but not all, of their weight on an injured leg. Canes are used on the side of the body opposite the injury. A cane of the proper height reaches the top of the wrist with the elbow slightly bent, according to the American Academy of Orthopaedic Surgeons (AAOS).

• A single crutch may be used similarly to a cane. If the patient is not able to put any weight on the injured area, then he or she may need to use two crutches. Crutches come in different or adjustable lengths to accommodate patients of various heights. According to the AAOS, crutches of the proper height will 1) reach about one inch from the underarms, 2) cause the elbows to bend slightly, and 3) have handgrips that reach the hips.

• When walking, the patient leans into the crutches, holding them tightly without allowing the underarms to absorb the body's weight. The crutches extend about one foot in front of the body, and the weight shifts to the crutches instead of the injured leg. Finally, the body swings forward.

• Splints and braces: Immobilizing the injured area is an important part of rest treatment. Splints and braces help protect and immobilize the injured body parts. These devices vary depending on where they are being used and the severity of the injury. A splint or brace may be made of plastic, fiberglass, plaster, foam, canvas, wood, or other material, combined with padding for extra support, according to the AAFP.

• Splints and braces are usually divided into two groups: rigid and functional. Rigid braces completely immobilize the injured area. Functional braces are semirigid and may allow slight movement. Splints and braces may have elastic bands or ties that hold the splint or brace around the injured area. They may allow for partial or complete joint movement by wrapping around the joint. There is some evidence that elastic bandages or other flexible braces may not provide enough support to immobilize the injured area.

• Ice: The second component of R.I.C.E. treatment is the application of ice to the injured area. Cold temperatures help reduce swelling.

• The use of ice is balanced against the negative effects of cold, which, when applied for too long, may cause frostbite or skin damage. (Long-term exposure to cold may damage nerves.) The NIAMS recommends applying cold to the injured area for no longer than 20 minutes 4-8 times daily. The cold pack should be removed if the injured area becomes numb, according to the AAFP. This treatment may be used for up to three days after the injury, according to the AAFP.

• Cold packs: There are several options for applying cold to an injured area. Plastic resealable bags filled with ice are an inexpensive form of ice pack, though it is necessary to wrap the bag in a towel before applying to the injured area to prevent the ice from causing skin damage. Reusable cold packs are filled with a gel or other substance that is repeatedly frozen.

• The AAFP suggests placing a wet towel around the injured area and then applying the ice pack, which is secured in place by an elastic bandage. Some bandages have a pouch to hold a bag of ice or cold pack, which protects the injured area from excessive cold.

• Ice baths and massages: According to the AAFP, two additional methods may be used: an ice bath and ice massage. An ice-slush bath is a container filled with water and ice. The injured body part is placed in the container until the area becomes numb. For small areas, the AAFP recommends massaging ice directly over the injury. Water frozen in an insulated cup may be massaged in circles over the area for 30 seconds.

• Compression: Similarly to cold packs, compression may relieve swelling and is the third component of R.I.C.E. treatment. Compression involves applying gentle pressure to the injured area. According to the National Athletic Trainers' Association, the most pressure is applied at the part of the injured area that is furthest from the heart. This is also where the bandage starts. It may be wrapped around the injured area toward the heart with the pressure decreasing the closer it is to the heart. The pressure should be sufficient to stabilize the area without cutting off blood flow, according to the AAFP. The injured area may be wrapped for one day to as long as one week, according to the AAFP.

• Equipment: Different equipment is used to apply pressure depending on the severity and location of the injury. Elastic bandages may be wrapped around the injured area to apply gentle pressure and secured by adhesive tape. Splints may also be used to apply pressure to an injured area.

• Air casts are typically used for ankle injuries. They compress and immobilize the injured area. Air casts are usually hard strips of plastic with pockets filled with air that run along each side of the ankle. An elastic band connects the strips and wraps underneath the foot. Several adhesive elastic bands wrap around the ankle and leg, securing the plastic braces in place.

• Elevation: Elevating the injured area also reduces swelling and is the fourth component of R.I.C.E. treatment. The injured body part is elevated above the heart, making it more difficult for blood to reach the injured area and cause swelling. A pillow or cushion may be used to elevate the injured area. Elevation also decreases bruising, which may cause pain or reduce range of motion, according to the AAFP. The injured area is elevated for 2-3 hours daily, according to the AAFP.

Theory/Evidence

• General: Sprains (tears or stretches to the ligaments that connect joints to bones) and strains (tears or stretches to the muscles or tendons that attach muscles to bones) are common injuries, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Bruising associated with tissue damage is also common. Bruises may occur during everyday activities or while playing sports.

• Although strains, sprains, and bruises are common injuries, they may be prevented by following several recommendations when playing a sport or doing everyday activities. Safe practices, safety equipment, and improved health may prevent these injuries. There is some evidence that the proper use of R.I.C.E. (rest, ice, compression, and elevation) treatment may reduce the need for anti-inflammatory drugs.

• Sprains: Common areas for sprains are ankles, wrists, thumbs, and knees, according to the NIAMS. Sprains usually occur while sliding (such as during a baseball game), jumping (landing on the side of the foot), falling (instinctively bracing the body with an arm), and twisting a knee, according to the NIAMS.

• Symptoms: Symptoms of sprains vary in severity depending on the extent of the injury. The more stretching or tearing of the ligament, the more severe the symptoms. In general, symptoms include not being able to put weight on or move the affected area, pain, bruising, and swelling.

• Grades: Sprains are divided into three grades based on severity of the injury.

• Grade I sprains are caused by minimal tearing or stretching of the ligament. Symptoms are mild and may include swelling and/or slight pain. There is usually little or no bruising or loss of mobility. Grade I sprains are the most common type of sprains, according to the American College of Sports Medicine.

• Grade II sprains involve moderate tearing or stretching and more severe bruising, pain, and swelling. There may be some loss of mobility, and the person may have difficulty putting weight on the affected area.

• Grade III sprains result from a complete tearing of the ligament and have severe symptoms.

• Seeking medical attention: Not all sprains require medical attention. Some sprains are mild and may heal on their own. The NIAMS suggests seeking medical attention for a suspected sprain if the injured area is: 1) numb, immobile, crooked, or lumpy; 2) the site of a previous injury; 3) very painful; and/or 4) no longer bearing weight.

• Diagnosis: To assess the injury's grade, a doctor may see if the patient is able to move or put weight on the affected area. Magnetic resonance imaging (MRI) is a diagnostic tool that allows the doctor to see if the ligament is completely torn. X-rays show if a bone break underlies the symptoms.

• Strains: Common areas for pulled or torn muscles and tendons, otherwise known as strains, are the hamstring muscle and the back, according to the NIAMS. Strains of certain areas are also common injuries in different sports. In general, strains are common injuries for contact sports (e.g., wrestling, soccer). Sports that require hitting and throwing (e.g., tennis, baseball) may cause frequent elbow strain injuries. Gripping sports (e.g., gymnastics, golf) may cause frequent hand and forearm strains.

• Symptoms: Symptoms for strains and sprains are similar. The more severe the strain, the more severe the symptoms. Swelling, pain, and loss of motion are common symptoms of strains. Since strains are caused by muscle injury, muscle weakness, spasms, or cramping may accompany an injury.

• Acute vs. chronic: Strains fall into one of two categories: acute or chronic. Chronic strains are usually caused by repeating the same movement over a long period of time, which results in the muscles becoming overworked. Acute strains are caused by a more recent injury wherein the muscles become overworked.

• Bruises: Bruises often happen when tissue is struck hard by an object. This may happen when a person is hit by someone's hand, a ball, or a hard surface in a fall, according to the National Athletic Trainers' Association (NATA). This causes blood vessels to break and blood to spill out into the tissue, turning it a dark color.

• Mild-to-moderate bruises usually heal and fade on their own with time. They may start as a brown or purplish color and change to shades of green, brown, or yellow before fading completely. Bruises may be accompanied by localized pain at the point of impact. There is some evidence that R.I.C.E. treatment minimizes internal bleeding in muscle tissue.

• Safe practices: Safe practices include keeping surfaces free of obstacles, clutter, and ice during the winter months. Surfaces should also be maintained, with all holes filled and bumps evened out.

• Warm up: According to the NATA, several factors decrease muscle elasticity and blood flow, which increases injury risk. This includes muscles that are overworked and cold. Athletes and people who exercise are at a higher risk for strain and sprain injuries when they do not warm up their muscles before activities. Warming up the muscles usually involves 5-10 minutes of light cardio exercise such as jogging, which causes the body to sweat slightly, according to the NATA.

• Stretching: Warm-ups should be followed by 5-10 minutes of stretching, which gently stretches the muscles without overstraining them. Different body parts require different stretches. It is important to follow proper form when stretching, which prevents injury.

• Safety equipment: When playing a sport or participating in another activity, wearing the appropriate safety equipment may help reduce the risk of injuries. This includes wearing body padding during contact sports such as hockey, gloves when boxing, helmets when playing football, or other recommended equipment for a given sport.

• Shoes: Wearing appropriate and properly fitting shoes may help prevent injury. It is also important to replace shoes when needed. After a period of time, the protective sole on a shoe may wear away and no longer provide the proper support. High-top athletic shoes may help immobilize the ankle and prevent injury.

• Good health: Overall good health may help prevent sprain and strain injuries during physical and everyday activities. A well-balanced diet that meets the person's nutritional requirements and a healthy weight help keep the body strong and properly functioning.

• Conditioning: Some sports or activities require special conditioning. For example, runners need to keep their joints in good health to prevent injuries. Baseball players may need significant upper-body strength to throw at high speeds. Basketball players need strong legs to jump and run. Muscle weakness and poor range of motion are risk factors for injuries. Previous injury and poor balance are also risk factors.

Safety

• General: R.I.C.E. (rest, ice, compression, and elevation) is a common treatment for sprains, strains, and bruises. Sprains and strains involve stretching or tearing of the ligaments or tendons, respectively. Sprains and strains may be mild to severe in nature. Bruising is caused by impact. Blood vessels in the tissue rupture and cause discoloration and pain.

• Although these injuries may be mild and not require medical attention, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) recommends seeking medical attention for sprain, strains, and bruises if the injured area is: 1) numb, immobile, crooked, or lumpy; 2) the site of a previous injury; 3) very painful; and/or 4) no longer bearing weight. The NIAMS suggests seeking help if the patient has any of these symptoms or a combination of the symptoms. Other indicators are an inability to walk more than four steps without pain and uncertainty about the severity or treatment of the injury.

• Sprains: Symptoms of sprains vary in severity depending on the extent of the injury. The more stretching or tearing of the ligament, the more severe the symptoms. In general, symptoms include not being able to put weight on or move the affected area, pain, bruising, and swelling.

• Ankle: Common ankle injuries are inverse injuries, or injuries that happen when the ankle moves inward, stretching or tearing the lateral ligaments (tissues that run along the outside of the ankle). This usually happens during jumping, falling, running, and turning.

• Knee: Ligaments run along the outside of the knee and within the knee joint. Knee sprains are fairly common and usually happen when the knee is twisted in a fall or hit. Some evidence suggests that the most common knee injury is injury to the medial collateral ligament (MCL). Injury to the anterior cruciate ligament (ACL) is another common knee injury.

• Wrist: Wrist sprain is also common and usually the result of a fall. The wrist twists or moves out of alignment when a person braces his or her body with an arm during a fall.

• Thumb: Thumb sprains are common injuries in some sports, including skiing. The ligament that connects the joint at the base of the thumb to the bones of the hand usually rips, causing a sprain.

• Lumbar: Injury to the ligaments of the lower back, or lumbar, region is common. Lumbar sprains may cause muscle spasms, stiffness, and difficulty maintaining good posture.

• Foot: Foot sprains usually involve two areas: the midfoot and first metatarsophalangeal joint. The midfoot region is the middle of the foot, including the arch. Sprains of the midfoot may be severe and accompanied by bone fractures or other injuries. At the base of the foot's largest toe is the first metatarsophalangeal joint. Sprains to this joint when the toe is bent backward at an extreme angle are often called turf toe.

• Neck: Whiplash (sudden, unexpected, and violent movement of the neck) and other movements may cause injury to the ligaments that connect the neck bones (also called the cervical vertebrae). Neck sprain symptoms are similar to the symptoms of other types of sprains and may also include sore throat and headache.

• Strains: Symptoms for strains and sprains are similar. The more severe the strain, the more severe the symptoms. Swelling, pain, and loss of motion are common symptoms of strains. Since strains are caused by muscle injury, muscle weakness, spasms, or cramping may accompany an injury.

• Hamstring: Athletes frequently injure one or more of the three hamstring muscles, located at the back of the leg. These muscles include biceps femoris, semimembranosus, and semiteninosus. The muscle may be stretched too far. A common hamstring stain injury is called eccentric contraction, when the muscle stretches as it is being exerted, according to the American Academy of Orthopaedic Surgeons (AAOS).

• Calf: The calf muscle, also called the gastrocnemius muscle, runs along the back of the lower leg. The muscle may be sprained when the foot bends upward at an extreme angle. The calf muscle stretches and may tear away from the Achilles tendon.

• Plantaris: The plantaris muscle connects the upper leg bone (femur) to the Achilles tendon at the heel by way of the knee joint. Plantaris strains may occur along with calf strains and ACL sprains. Pain from a plantaris strain may be felt in the calf.

• Quadriceps: The quadriceps muscle is found in the front of the upper leg. A strain of the quadriceps muscle that is located close to the pelvis may be called a groin pull.

• Lumbar: Injury to the lower back, or lumbar, musculature is common. Extensor muscles extend through the back and gluteus (or buttock). Oblique muscles wrap around the sides of the back. Lumbar strains may cause muscle spasms, stiffness, and difficulty maintaining good posture.

• Hip: Several muscles attach to the large bones that connect at the hip joint. The muscles may attach to the lower leg, buttocks, and abdomen. Hip strains commonly occur when the muscles suddenly contract when extended, according to the AAOS.

• Bruises: Bruises may occur on the bones, muscles, or skin throughout the body. Some people are more likely to bruise. They may have a certain disease, take a medication, or have thinner skin, according to the Nemours Foundation. Bruises may cause discoloration of the skin, bumps, swelling, and pain in the injured area.

Author Information

• This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

1. American Academy of Family Physicians (AAFP). www.aafp.org

2. American Academy of Orthopaedic Surgeons (AAOS). www.aaos.org

3. American College of Sports Medicine (ACSM). www.acsm.org

4. Bleakley CM, O'Connor S, Tully MA, et al. 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]. BMC Musculoskelet Disord. 2007 Dec 19;8:125. View Abstract

5. Ivins D. Acute ankle sprain: an update. Am Fam Physician. 2006 Nov 15;74(10):1714-20. View Abstract

6. Järvinen TA, Järvinen TL, Kääriäinen M, et al. Muscle injuries: optimising recovery. Best Pract Res Clin Rheumatol. 2007 Apr;21(2):317-31. View Abstract

7. National Athletic Trainers' Association (NATA). www.nata.org

8. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). www.niams.nih.gov

9. National Library of Medicine. www.nlm.nih.gov

10. Natural Standard: The Authority on Integrative Medicine. www.naturalstandard.com

11. Paoloni JA, Milne C, Orchard J, et al. Non-steroidal anti-inflammatory drugs in sports medicine: guidelines for practical but sensible use. Br J Sports Med. 2009 Nov;43(11):863-5. View Abstract

12. Petrella MJ, Cogliano A, Petrella RJ. Original research: long-term efficacy and safety of periarticular hyaluronic acid in acute ankle sprain. Phys Sportsmed. 2009 Apr;37(1):64-70. View Abstract

13. U.S. Centers for Disease Control and Prevention (CDC). www.cdc.gov

14. World Health Organization (WHO). www.who.int