How to treat damaged soft tissues with RICE

Brian Mackenzie explains how the body reacts to injury and provides advice on treating soft tissue injuries.

Cryotherapy is the use of cooling as a means of treating injuries and may be used in different ways on both acute and chronic injuries. Much research has been carried out on the effects of cooling on damaged soft tissues, and although the benefits are now widely accepted there are varying opinions on how long the application should be to gain maximum benefit. There are still many athletes who believe a long soak in a hot bath after an injury is the best remedy to ease the pain.

The body's reaction to an injury

In many instances, no matter how small the injury, tissues will have either been stretched or an impact received, causing blood vessels to be torn or damaged. The extent of bleeding will depend on the vascularity of the tissues involved and may also be increased if injured during exercise. Blood will flow out until the vessels are restricted (vasoconstriction), so preventing further blood from leaking into the tissues. It is vital to stop bleeding into tissues as the blood will act as an irritant, increase inflammation, and must be cleared from the tissues before the healing process can properly commence.

Cells starved of nourishment from the blood due to injury will soon die. These dying cells stimulate the release of histamine, causing the blood vessels to dilate, thereby bringing increased blood supply and extra nutrients to help repair and rebuild the damaged tissues. During this phase of increased but slower and more dense blood supply, the capillary walls become much more permeable, and quantities of protein and inflammatory substances are pushed into the area, causing swelling. Various reactions continue at a rapid rate, all contributing to the healing process. Muscle spasms may also occur, causing the muscle to contract either voluntarily or involuntarily, helping prevent further movement. However, this may have adverse effects by further restricting blood flow and also placing more pressure on nerve endings, leading to increased pain.

RICE

By applying ice or cooling immediately after an injury involving damage to soft tissues, the level of swelling and amount of blood allowed to leak out may be substantially limited. This will also be assisted by compression, elevation, and rest, hence "ICER", (or more commonly "RICE)

Ice - Apply ice for up to 10 minutes as soon after the injury as possible - do not wait for the swelling to start. This may be repeated every 2 hours during the first two days after an injury. It is important not to keep the ice on any longer than 10 minutes as the body then reacts by increasing blood flow to warm the area and therefore exacerbating the swelling. Do not apply ice directly to the skin. Use a damp cloth between the skin and the ice pack
Compression - After ice, apply a compression bandage to help minimise the swelling to the tissues
Elevation - Elevate the injured part to help limit blood flow and prevent the use of muscles in the injured part
Rest - The injured part should be rested as much as possible to allow the healing of damaged tissues

Failure to do this means that the period of recovery from injury may be considerably extended whilst the swelling and removal of dead tissue and blood cells are dealt with. If severe and not properly managed, this may create long-term problems for the athlete.

Use of Ice

When applying ice, never do so directly onto the skin as this may result in ice burns to the skin. Wrap the ice in a damp cloth (a dry cloth will not transmit cold effectively). There is an ongoing debate over how long to apply ice. Current research suggests that during the acute phase (i.e. first 24-48 hours after injury) ten minutes is the maximum time needed and may be adjusted downwards according to the depth of tissues it is being applied to. Application for the appropriate time must be repeated every 2 hours during the acute phase. Once only after an injury is not enough. If the ice pack is left on for more than 10 minutes, a reflex reaction occurs (Hunting effect) where the blood vessels dilate, and blood is again pumped into the injured area, causing further bleeding and swelling.

Ice will have an analgesic effect on the injured part by limiting the pain and swelling, and muscle spasms may also be reduced. Whilst this has obvious benefits, be cautious about reducing the pain, as this may also mask the seriousness of the injury. After the initial healing period of up to 72 hours (depending on the severity of the injury). Ice massage may be incorporated into treatments. By applying stroking movements with an ice pack, the blood vessels will dilate, and constrict alternately bringing an increased supply of blood and nutrients to the area, and so increasing the rate of healing. This may be done for more than 10 minutes to increase circulation.

Contraindications of using ice

Check a person's general sensitivity to ice - some people find the application of cold immediately painful
Do not use ice on injuries in the chest region as in some instances this may cause a reaction in the muscles, bringing about anginal pain, possibly from the constriction of coronary arteries
Always check skin sensitivity before applying ice - if a person cannot feel touch before applying ice, this may indicate other problems such as nerve impingement. In such instances, ice would only serve to mask this and complicate the problem
Do not apply cold to someone with high blood pressure, as vasoconstriction will increase the pressure within the vessels

Education

It is important to educate anyone managing injuries, including athletes themselves on at least the essential use of ice on soft tissue injuries - early treatment is vital.

Article Reference

This article first appeared in:

MACKENZIE, B. (2003) How to treat damaged soft tissues with RICE. Brian Mackenzie's Successful Coaching, (ISSN 1745-7513/ 2 / June), p. 2-3

Page Reference

If you quote information from this page in your work, then the reference for this page is:

MACKENZIE, B. (2003) How to treat damaged soft tissues with RICE [WWW] Available from: https://www.brianmac.co.uk/articles/scni2a2.htm [Accessed

About the Author

Brian Mackenzie is a British Athletics level 4 performance coach and a coach tutor/assessor. He has been coaching sprint, middle distance, and combined event athletes for the past 30+ years and has 45+ years of experience as an endurance athlete.


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Cryotherapy is the use of cooling as a means of treating injuries and may be used in different ways on both acute and chronic injuries. Much research has been carried out on the effects of cooling on damaged soft tissues, and although the benefits are now widely accepted there are varying opinions on how long the application should be to gain maximum benefit. There are still many athletes who believe a long soak in a hot bath after an injury is the best remedy to ease the pain. The body's reaction to an injury In many instances, no matter how small the injury, tissues will have either been stretched or an impact received, causing blood vessels to be torn or damaged. The extent of bleeding will depend on the vascularity of the tissues involved and may also be increased if injured during exercise. Blood will flow out until the vessels are restricted (vasoconstriction), so preventing further blood from leaking into the tissues. It is vital to stop bleeding into tissues as the blood will act as an irritant, increase inflammation, and must be cleared from the tissues before the healing process can properly commence. Cells starved of nourishment from the blood due to injury will soon die. These dying cells stimulate the release of histamine, causing the blood vessels to dilate, thereby bringing increased blood supply and extra nutrients to help repair and rebuild the damaged tissues. During this phase of increased but slower and more dense blood supply, the capillary walls become much more permeable, and quantities of protein and inflammatory substances are pushed into the area, causing swelling. Various reactions continue at a rapid rate, all contributing to the healing process. Muscle spasms may also occur, causing the muscle to contract either voluntarily or involuntarily, helping prevent further movement. However, this may have adverse effects by further restricting blood flow and also placing more pressure on nerve endings, leading to increased pain. RICE By applying ice or cooling immediately after an injury involving damage to soft tissues, the level of swelling and amount of blood allowed to leak out may be substantially limited. This will also be assisted by compression, elevation, and rest, hence "ICER", (or more commonly "RICE) Ice - Apply ice for up to 10 minutes as soon after the injury as possible - do not wait for the swelling to start. This may be repeated every 2 hours during the first two days after an injury. It is important not to keep the ice on any longer than 10 minutes as the body then reacts by increasing blood flow to warm the area and therefore exacerbating the swelling. Do not apply ice directly to the skin. Use a damp cloth between the skin and the ice pack Compression - After ice, apply a compression bandage to help minimise the swelling to the tissues Elevation - Elevate the injured part to help limit blood flow and prevent the use of muscles in the injured part Rest - The injured part should be rested as much as possible to allow the healing of damaged tissues Failure to do this means that the period of recovery from injury may be considerably extended whilst the swelling and removal of dead tissue and blood cells are dealt with. If severe and not properly managed, this may create long-term problems for the athlete. Use of Ice When applying ice, never do so directly onto the skin as this may result in ice burns to the skin. Wrap the ice in a damp cloth (a dry cloth will not transmit cold effectively). There is an ongoing debate over how long to apply ice. Current research suggests that during the acute phase (i.e. first 24-48 hours after injury) ten minutes is the maximum time needed and may be adjusted downwards according to the depth of tissues it is being applied to. Application for the appropriate time must be repeated every 2 hours during the acute phase. Once only after an injury is not enough. If the ice pack is left on for more than 10 minutes, a reflex reaction occurs (Hunting effect) where the blood vessels dilate, and blood is again pumped into the injured area, causing further bleeding and swelling. Ice will have an analgesic effect on the injured part by limiting the pain and swelling, and muscle spasms may also be reduced. Whilst this has obvious benefits, be cautious about reducing the pain, as this may also mask the seriousness of the injury. After the initial healing period of up to 72 hours (depending on the severity of the injury). Ice massage may be incorporated into treatments. By applying stroking movements with an ice pack, the blood vessels will dilate, and constrict alternately bringing an increased supply of blood and nutrients to the area, and so increasing the rate of healing. This may be done for more than 10 minutes to increase circulation. Contraindications of using ice Check a person's general sensitivity to ice - some people find the application of cold immediately painful Do not use ice on injuries in the chest region as in some instances this may cause a reaction in the muscles, bringing about anginal pain, possibly from the constriction of coronary arteries Always check skin sensitivity before applying ice - if a person cannot feel touch before applying ice, this may indicate other problems such as nerve impingement. In such instances, ice would only serve to mask this and complicate the problem Do not apply cold to someone with high blood pressure, as vasoconstriction will increase the pressure within the vessels Education It is important to educate anyone managing injuries, including athletes themselves on at least the essential use of ice on soft tissue injuries - early treatment is vital. Article Reference This article first appeared in: MACKENZIE, B. (2003) How to treat damaged soft tissues with RICE. Brian Mackenzie's Successful Coaching, (ISSN 1745-7513/ 2 / June), p. 2-3 Page Reference If you quote information from this page in your work, then the reference for this page is: MACKENZIE, B. (2003) How to treat damaged soft tissues with RICE [WWW] Available from: https://www.brianmac.co.uk/articles/scni2a2.htm [Accessed About the Author Brian Mackenzie is a British Athletics level 4 performance coach and a coach tutor/assessor. He has been coaching sprint, middle distance, and combined event athletes for the past 30+ years and has 45+ years of experience as an endurance athlete.