Updating RICE
Rest, Ice, Compression, Elevation or commonly called RICE has been the acronym and method used for treating acute injuries since the 1970s. This strategy focused on off loading tissues and controlling inflammation to elicit optimal healing. However, research has evolved over the last 50 years and it is time for an update. The two modern numonics being used are PEACE and LOVE. PEACE is used immediately after an injury and LOVE is used in the following days to rehabilitate the injury. Today we are going to break down the basics of PEACE and in our next blog we will break down LOVE.
PEACE stands for Protect, Elevate, Avoid Anti-Inflammatories, Compression, and Educate. The first step is to Protect the injured area. Protect is during the first 1-3 days where you want to unload and reduce the amount of movement a tissue has. This is not a complete lack of motion, just a reduction. This allows tissues to start to heal and not sustain further damage. The reduction of motion should be through painful ranges, gentle, pain free motion is still allowed. Complete rest is never ideal since it leads to decrease in muscle size, and strength in as little as 5 days.
The second step is to Elevate the injured area. This should be done to a height higher than the heart. This helps the fluids associated with inflammation to cycle back into the body instead of pooling at the injured area. While the research has not demonstrated an overly large benefit from elevation, it has a very low risk and pairs well with off loading tissues. Fluid exchange is substantially important for an injured area as pooling of fluids can lead to stagnation and increased healing time.
The third component of PEACE is Avoid anti-inflammatories. This is because inflammation is required for tissues to heal properly and if that process gets cut short, healing times can increase. This is also why cryotherapy (ice) is often no longer recommended. This also cuts inflammation which can have a negative impact overall on the tissue repair. Ice can be used as a pain management tool but should not be used in excess.
The fourth piece is Compression. Compression consists of things like taping and wraps squeezing an area to help with fluid mechanics and pain. Compression is the ideal tool to control inflammation because it improves fluid mechanics without cutting the inflammation/healing process short. Compression can also change the perception of pain from an area by stimulating different receptors in the area to help override the pain signal. This is why when you hit a finger, you hold it reflexively for a few seconds and then soon as you let go, the pain hits. Compression should be avoided around the neck, as well as when there is a suspected break in a bone. Always get suspected breaks immediately examined by an expert.
The final step is to Educate the patient. Once a patient understands their condition and knows that there is a plan forward, many underlying fears become resolved. Patients should always be taught the value of an active load management strategy instead of chasing passive, feel better tricks, looking for a magic cure. The incredible resiliency of the body is that we can sustain and recover from massive injuries. An educated patient is a compliant patient who will take part in the recovery process if they understand what their role is.
With the advancement of research, so must the protocols we follow advance as well. This updated approach to soft tissue injury contains some of the tenets of RICE but with a modern touch. So the next time you sustain an injury, don’t have RICE, have a little PEACE instead.
McGriff-Lee N. Management of Acute Soft Tissue Injuries. Journal of Pharmacy Practice. 2003;16(1):51-58.
