Recovery From Injuries – The Price Is Right!

Most of us are familiar with the idea that we have to “RICE” an injury, but I wonder how many are aware of why we do it and what we should actually be doing?

Firstly, why do we do it?  Research to date has shown that, when we incur an injury, some inflammatory response is absolutely necessary in order to facilitate the healing process, but too much will cause the injury to take longer to recover and potentially interfere with range of movement. Therefore we want a controlled inflammatory response, which we seek to do by applying RICE.

The first thing to say is that the moments after you incur an injury are the most important of all. What you do in this period will have a huge bearing on how you recover. That’s why I’m going to add an additional letter to the acronym and make it PRICE!

Thereafter ,the first 48 hours after are an injury are also vitally important. Getting the treatment right at this stage can make the difference between a successful, short recovery and months (or even years) of pain, discomfort and impairment of function.

So, what does it all mean?

P – PROTECT

Immediately when an injury occurs, it is important to protect the injured area from suffering further harm. 

That means taking all steps to stop the activity which has caused the injury in the first place. We’re all tempted to “run it off”, but generally we know the difference between a bit of discomfort and an injury and no good will come of continuing to put stress on the latter (quite the opposite). Stop doing whatever caused the injury and get yourself back to a “safe” place as easily as possible.

And, if you can, get ice on the injury as soon as possible. We’ve probably all seem images of footballers being subbed with an injury and the physio getting them to sit in the dugout with an ice pack attached. Do the same yourself.

Control the initial swelling now and you’ll make a huge difference to your recovery. In fact, if you can, adhere to all the principles of RICE as set out below.

It’s worth carrying a “freeze pack” in your car or, in some cases, in your kit bag or first-aid kit. These are one-use packs which are great for putting straight onto an injury. They’ve got some in Run4It and I’d really recommend popping in and getting one....you never know when you might need it!

And avoid alcohol! Tempting though it is to head to the bar and console yourself with a pint or two, alcohol can interfere with the inflammatory process, which is the last thing you want to do when everything else if geared towards controlling it.

R – REST

Rest is essential in order to allow the initial healing process to take place properly over the first 48 hours. Don’t be tempted to go out there and “test it”. Keep the injury rested and free from any stress, with very little mobilisation.

I – ICE

As mentioned at the start of the article, the main purpose of RICE is to allow for a controlled inflammatory response. Ice does this, principally by taking the temperature of the affected area down which reduces metabolism. The reduced blood supply means that the inflammatory response will be reduced.

In addition, ice can also have the effect of reducing pain by reducing tissue temperature and can reduce muscle spasm and neural inhibition.

So how do you ice? That’s the question I get asked more than any other. In fact, there is no set agreed method. There is some research suggesting that the vast majority of reduction in tissue temperature takes place in the first 10 minutes, and very little thereafter. So I’d recommend 10 minutes of icing, followed by 10 minutes of “rest”, repeated several times. Do this at regular intervals throughout the 2 days following the injury (as much as normal routine allows!).

And what do you use? Personally, I’d recommend gel packs, which are placed in the freezer to get them cold and which are malleable so can fit to an injury. Again, Run4It have some packs in stock ( which can also be heated in the microwave and used as heat packs) and it’s well worth getting hold of one.

Alternatively, most of us will have used a pack of peas or similar at some point. Perfectly good, but I have found myself having to throw the peas away after several thaw and refrost cycles!

Note: ice applied directly to the skin can and will burn and you should therefore use a protective barrier. I find a thin tea-towel to be ideal.

Finally on icing, there are a number of “freeze gels” available on the market. Whilst I wouldn’t use these if it’s possible to ice as above, some people may find that, due to restrictions at their place of work or the nature and location of the injury, it’s not possible to use an ice pack during the day. In these circumstances, freeze gels have been shown to be effective in reducing tissue temperature. I’ve used Biofreeze in the past and I’ve noticed that it is now available to purchase on Amazon.

C – COMPRESSION

Compression has the effect of constricting blood flow to the area, again helping to control the inflammatory response. In order to do this, bandage the affected area firmly but not so tight that it is uncomfortable. Tubular bandages are now available for a number of areas of the body, which will do this job effectively. Also, many athletes now wear compression gear and this is also effective.

(As an aside, whilst I am still very much undecided as to whether the wearing of compression gear during exercise is of any benefit, on the basis of RICE, the wearing of compression gear after exercise is definitely based on sound principles and something I would recommend).

E – ELEVATION

Keep the area elevated above the heart to restrict blood flow and reduce the pressure of fluids on the affected area. Of course, this might be easier to do with an arm injury than with a sprained ankle. However, take all steps you can to adhere to this principle. Can you put your foot up on a stool or another chair at work? Can you work with the laptop on your chest at home?

After the initial 48-72 hours, the healing process has commenced and it’s time to adapt the recovery strategy to MICE! The rest is replaced by some movement of the affected area, since it is important that the collagen fibres (scar tissue) which are laid down to repair the area are moulded to assist the proper movements of the muscles rather than restrict them. Keep movements within a comfortable range and don’t force any stretches on the affected area, this might cause re-injury.

At this stage, sports massage will also be of great assistance by helping to mould the scar tissue along the same lines as the muscles.

As long as swelling has gone from the area, then it’s time to move on to MICES, the S signifying “stretching”. Again, this helps mould the scar tissue to perform with the muscle rather than inhibiting it and ensures that the full range of movement is regained. The key is to stretch but not over-stretch and re-damage the tissues. It’s a graduated process and, indeed, some advisors will talk of a “recovery ladder” process, whereby you push a bit further each time, stepping back down the ladder if there is onset of pain. I’m a great advocate of this approach, taking the recovery back to basics and, for example, going out for just a 1 mile run initially, then increasing slowly on each subsequent run, but stopping if pain returns and dropping back down the distances. It’s had great results with some people I’ve seen recently, I just need to take my own advice now!

Hopefully, that’s given folk an idea of why we use RICE after injury and how to do it, and also some idea on the timescales involved and how and why we want to move on to movement and then stretching as soon as practical. If anyone has any comments or queries, feel free to get in touch.