The RICE protocol: your ally against injuries
Sport is a healthy activity. However, it can also lead to injury. One of the most common is ankle sprains (1). This is where the RICE protocol comes in.
It is a widely recommended method of first aid (2). It is used for the initial treatment of sports injuries. In this article, we will explore this protocol in detail.
We will see how it can be your ally against sports injuries, but not only. .
Definition and origin of the RICE protocol
RICE stands for Rest, Ice, Compression, Elevation. This method was first introduced in the 1970s. It has become a standard in the field of sports medicine. Initially developed by Dr. Gabe Mirkin in 1978, it has grown in popularity. (3)
Since its introduction, the RICE protocol has been widely adopted. It is often cited in first aid guides for injuries (2).
The stages of the RICE protocol
Applying the RICE protocol requires following four distinct steps. Each component plays a specific role in the treatment of sports injuries. Following the steps ensures effective reduction of pain and swelling. (2)
It is crucial to start the RICE protocol as soon as possible after the injury. This maximises its benefits by preventing further damage. By knowing and applying each step correctly, you can contribute to a quick and complete recovery.
The symptoms should begin to subside as the protocol is applied. If this is not the case, medical follow-up is advised. Carefully monitoring progress helps to adjust the duration of each phase as needed. (2)
Although simple, the protocol requires attention and discipline. Each component must be performed correctly to derive the greatest benefit. Let's look at these four steps in detail to better understand their importance.
R: Rest
Rest is the first step in the RICE protocol. It allows the body to begin the healing process. When you are injured, continuing to use the injured part can make the situation worse. It is therefore essential to stop all activity immediately (3). Rest also reduces the risk of further injury. For optimal effectiveness, avoid putting weight on the affected area until it has improved.
I: Ice
Applying ice is crucial for controlling inflammation and pain. It should be done quickly after the injury. Ice reduces blood flow to the affected area, which reduces swelling and pain (3). It is recommended that you apply a bag of ice for 15 to 20 minutes every two to three hours for the first 48 hours or until the oedema and inflammation have stabilised. Make sure you place a protective layer, such as a cloth, between the ice and the skin. This helps prevent burns (2).
C: Compression
Compression stabilises the joint or injured area. It helps to control swelling by reducing the build-up of fluid in the tissues and maintain range of motion. Use an elastic or compression bandage to gently wrap around the affected area (2). It is essential not to tighten the bandage too tightly. Excessive compression can impair blood circulation. Check regularly for signs of circulation, such as the absence of tingling.
E: Elevation
Elevation is often a neglected but fundamental step. By raising the injured part above the level of the heart (15 to 25 cm), you facilitate venous and lymphatic drainage. This helps to reduce swelling. (2)
Try to keep the injured area elevated as much as possible until the oedema begins to subside. For example, rest your foot on a cushion when you are lying down. Elevation also improves venous return, which aids recovery.
Application of the RICE protocol to ankle sprains
Ankle sprains are among the most common injuries in athletes. The RICE protocol is often recommended for their initial treatment. The prompt application of this protocol can reduce pain and healing time and minimise complications.
When a sprain occurs, the ankle ligaments are stretched or torn (4). The RICE protocol allows for effective recovery. It helps limit damage while promoting tissue regeneration.
However, patience is crucial. Don't rush your return to normal activities. The body needs time to strengthen the ligaments and other damaged tissues.
Anti-inflammatory or analgesic medication (5) can be used as a supplement, but consult a doctor before using them. Wearing an ankle brace can also help. Finally, keep in mind the importance of a well-followed rehabilitation programme.
Recognising an ankle sprain
To treat an ankle sprain effectively, it must first be identified.
To learn about and distinguish the 3 different stages of a sprain (mild sprain, moderate sprain and severe sprain), see our full article on ankle sprains.
If you feel pain that suggests a sprain, fracture, tendonitis or any other condition, consult a healthcare professional to establish a diagnosis for optimal treatment. This may include a clinical examination (including X-rays) or a physical examination. (6) A sprain that is not properly treated can lead to weakness later on.
Medical follow-up and rehabilitation
Consulting a healthcare professional is essential for serious injuries or if symptoms persist. An accurate diagnosis allows for targeted rehabilitation.
The doctor may recommend rehabilitation exercises to restore strength and flexibility. These exercises should be progressive and tailored to individual needs.
Physical therapy can greatly improve the healing process. (6) It helps to strengthen weakened ligaments and prevent future injuries.
Be sure to follow the specialist's advice and prescriptions to avoid relapses. Finally, education on injury prevention is a major asset for your future sports practice. This way, you can take a proactive approach to managing your health.
Remember that the RICE protocol is an emergency measure, and medical follow-up may be necessary, or even surgery, for ankle sprains with complete ligament tears (grade III). Appropriate use of the protocol can greatly influence the outcome of recovery (2).
Sources
(1) Waterman BR, Owens BD, DaveyS, ZacchilliMA, Belmont PJ Jr. The epidemiologyof anklesprainsin the United States. J Bone Joint SurgAm. 2010 Oct6;92(13):2279-84. doi: 10.2106/JBJS.I.01537. PMID: 20926721.
(2) Wolfe MW, Uhl TL, Mattacola CG, McCluskey LC. Management of ankle sprains. Am Fam Physician. 2001 Jan 1;63(1):93-104. Erratum in: Am Fam Physician 2001 Aug 1;64(3):386. PMID: 11195774.
(3) Academy, U. S. (2020, 30 octobre). The R.I.C.E Protocol is a MYTH : A Review and Recommendations. The Sport Journal. https://thesportjournal.org/article/the-r-i-c-e-protocol-is-a-myth-a-review-and-recommendations/
(4) Melanson SW, Shuman VL. Acute Ankle Sprain. [Updated 2023 May 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459212/
(5) Vuurberg G, Hoorntje A, Wink LM, et alDiagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guidelineBritish Journal of Sports Medicine 2018;52:956. https://doi.org/10.1136/bjsports-2017-098106
(6) Haute Autorité Santé ,” DISPOSITIFS de COMPRESSION/CONTENTION médicale à usage individuel Utilisation en ORTHOPÉDIE/ RHUMATOLOGIE/ TRAUMATOLOGIE”; Octobre 2012 (consulté le 07/10/2024). HAS : https://www.has-sante.fr/jcms/c_1318289/fr/dispositifs-de-compression/contention-medicale-a-usage-individuel-utilisation-en-orthopedie/rhumatologie/traumatologie
Crédits : Thuasne / Canva