Chronic injuries may require physical therapy after doctor's diagnosis.
R.I.C.E. Treatment
Rest, Ice, Compression, Elevation
First aid for strains, sprains, contusions, dislocations, or uncomplicated fractures
Rest
Stop using injured part
Continued activity could cause further injury, delay healing, increase pain, and stimulate bleeding
Use crutches to avoid bearing weight on injuries of the leg, knee, ankle, or foot
Use splint for injuries of the arm, elbow, wrist, or hand
Ice
For 3 days after injury
Apply every hour for 10 to 20 minutes
Do not apply ice for longer than 15 to 20 minutes at a time
Apply ice after 3 days as long as pain or inflammation persist
Apply at least 3 times throughout the day for 15 to 20 minutes
Compression
Hastens healing time by reducing swelling around injury
Decreases seeping of fluid into injured area from adjacent tissue
Use elasticized bandage, compression sleeve, or cloth
Wrap injured part firmly
Do not impair blood supply
Too tight compression may cause more swelling
Wrap over ice
Loosen the bandage if it gets too tight
Elevation
Elevate injured part above level of heart
Decreases swelling and pain
Use objects and pillows for props
Some texts advocate PRICES (P=Protection, S=Support)
Questioning RICE Guidelines
For injuries causing only minor swelling and pain while allowing almost complete range of motion, some experts including Dr Gabe Mirkin, MD, the same doctor who coined the term RICE (Mirkin 1978) now question the Rest and Ice parts of the treatment (Byrne 2016).
It was though for years that the application of ice following a sprain or strain injury would reduce swelling and pain. After reviewing the more recent literature, Dr Mirkin stated:
“Ice doesn’t increase healing – it delays it.” (Byrne 2016)
NSAIDs
A more effective therapy for reducing pain and improving short-term function is non-steroidal anti-inflammatory medication such as Ibuprofen (Advil, Motrin) or Naproxen (Aleve) but only for the first 24 to 48 hours because they too can slow down recovery by suppressing inflammation (NATA 2013). High doses of anti-inflammatory medicines can inhibit muscle growth and strength (Lilja 2017)
Heat Treatment
There is limited overall evidence to support the use of topical heat in general (Malanga 2015)
However, heat-wrap therapy can provide short-term reductions in pain and disability
Heat therapy can cause a delay in healing if applied too soon after an injury
Thermotherapy during the acute (first 2-4 days) and subacute phase (up to 6 weeks) of injury due to lack of evidence and the potential to exacerbate the injury (NATA 2013).
Immobilization
Immobilization is still recommended for more serious injuries (eg grade III sprains). However, for less serious injuries (eg grade I and II sprains), gentle movement exercise within the first 48 to 72 hours two to three times daily decrease recovery time (NATA 2013, Byrne 2015). Functional treatment appears to be the favorable strategy for treating acute ankle sprains when compared with immobilization (Kerkhoffs 2002).
Recovery
There will be a prolonged healing time if usual activities are resumed too soon.
Proper care and sufficient healing time before resuming activity should prevent permanent disability if it is a first-time injury.
If it is a repeat injury, complications are more likely to occur.
Injury to the muscle or tendon. Pain with moving or stretching the affected muscle or muscle spasms. Acute strains are caused by over stress or direct injury. Chronic strains are caused by overuse.
Mild strain (Grade I):
Slightly pulled muscle with no tearing of muscle or tendon. No loss of strength
Ability to produce strong yet painful muscle contractions
Requires self-care through rehabilitation after doctor's diagnosis
Average healing time: 2 to 10 days
Moderate strain (Grade II):
Tearing of muscle, tendon or at the bone attachment
Weak and painful attempts at muscular contraction
Requires physical therapy after doctor's diagnosis
Average healing time: 10 days to 6 weeks
Severe strain (Grade III):
Rupture of muscle-tendon-bone attachment with separation
Extremely weak yet painless attempts at muscular contraction
Requires surgical repair and physical therapy after doctor's diagnosis
Average healing time: 16 to 10 weeks
Sprain
Violent overstretching of ligament in a joint. Pain, tenderness, swelling or bruising at joint.
Mild strain (Grade I):
Tearing of some ligament. No loss of function
Requires self-care through rehabilitation after doctor's diagnosis
Average healing time: 2 to 6 weeks
Moderate strain (Grade II):
Rupture of portion of ligament resulting in some loss of function
Requires physical therapy after doctor's diagnosis
Average healing time: 6 to 8 weeks
Severe strain (Grade III):
Complete rupture of ligament or complete separation of ligament from bone. A sprain-fracture occurs when the ligament pulls loose a fragment of bone
1+ Joint surfaces displaced 3-5 mm
2+ Joint surfaces displaced 6-10 mm
1+ Joint surfaces displaced 10+ mm
Requires surgical repair and physical therapy after doctor's diagnosis
Average healing time: 8 to 10 weeks
Injury Information
Acute (traumatic injury)
Chronic (overuse injury)
Account for more than 50% of injuries in primary care practices
Classification Stages:
Pain after activity only
Pain during activity. Does not restrict performance
Pain during activity. Restricts performance
Chronic persistent pain, even at rest
See a qualified health care provider (ie: physician) if you have an injury. Educate yourself about your injury. See medical links. One starting place on the internet is the Merck Manual's Orthopedic Injuries. A medline or PubMed search can give you ideas about your condition and therapeutic modalities. Several medline links can be found on the ExRx.net. A university library will provide a wealth of information. You may not be able to checkout resources if you are not a student, but you can read and copy materials.
Crown LA, Hizon JW, Rodney WM (1997). Musculoskeletal Injuries in Sports, The Team Physician's Handbook, Mosby, 2: 361-370.
Griffith HW (1986) Complete Guide to Sports Injuries, The Barkley Publishing Group,
Kaminski TW, Hertel J, Amendola N, Docherty CL, Dolan MG, Hopkins JT, Nussbaum E, Poppy W, Richie D; National Athletic Trainers' Association (2013). National Athletic Trainers' Association position statement: conservative management and prevention of ankle sprains in athletes. J Athl Train; 48(4):528-45.
Kerkhoffs GM, Rowe BH, Assendelft WJ, Kelly K, Struijs PA, van Dijk C (2002). Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults. Cochrane Database Syst Rev; (3) CD003762.
Lilja M, Mandić M, Apró W, Melin M, Olsson K, Rosenborg S, Gustafsson T, Lundberg TR (2017). High doses of anti-inflammatory drugs compromise muscle strength and hypertrophic adaptations to resistance training in young adults. Acta Physiol; doi: 10.1111/apha.12948. [Epub ahead of print].
Malanga GA, Yan N, Stark J (2015). Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med;127(1):57-65.
Mirkin G (1978). The Sports Medicine Book. Little, Brown, and Company.
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