The RICE method—Rest, Ice, Compression, Elevation—has been a long-standing first aid protocol for managing acute soft tissue injuries like sprains and strains. However, recent research and clinical practice have prompted healthcare professionals to re-evaluate its effectiveness. While RICE can provide initial relief, it may not always be the best or most up-to-date approach for promoting optimal healing.

Evolving Perspectives on Injury Management

Limitations of Complete Rest

• Delayed Healing: Prolonged rest can lead to muscle atrophy and joint stiffness.

• Reduced Blood Flow: Inactivity may decrease circulation, slowing down the healing process.

The Role of Inflammation

• Natural Healing Process: Inflammation is a crucial part of tissue repair.

• Ice Controversy: Excessive icing might impede the inflammatory process necessary for healing.

Updated Protocols: POLICE and PEACE & LOVE

POLICE: Protection, Optimal Loading, Ice, Compression, Elevation

• Protection: Safeguard the injured area to prevent further damage.

• Optimal Loading: Introduce gentle movements early to promote tissue healing.

• Ice: Used sparingly to manage pain but not to the extent of hindering inflammation.

• Compression and Elevation: Continue to reduce swelling.

PEACE & LOVE

Immediately after injury (PEACE):

• Protection

• Elevation

• Avoid Anti-inflammatories: To not interfere with the natural healing process.

• Compression

• Education: Understanding the injury promotes better self-care.

After the initial phase (LOVE):

• Load: Gradually introduce movement.

• Optimism: Positive mindset aids recovery.

• Vascularisation: Light cardiovascular activity increases blood flow.

• Exercise: Tailored exercises restore strength and flexibility.

Why the Shift?

• Early Movement Benefits: Facilitates tissue repair and prevents joint stiffness.

• Inflammation is Beneficial: Essential for healing; suppressing it may delay recovery.

• Holistic Approach: Addresses both physical and psychological aspects of healing.

Chiropractic Perspective on Modern Injury Management

As chiropractors, we advocate for evidence-based practices that promote efficient healing:

• Assessment and Individualization: Each injury is unique; treatment plans should be tailored accordingly.

• Active Rehabilitation: Incorporating exercises that restore function without overloading the injury.

• Patient Education: Empowering you with knowledge about your injury and recovery process.

• Adjunct Therapies: Utilizing techniques like laser therapy or kinesio taping to support healing.

Practical Steps for Managing Sprains and Strains

1. Protect the Injury: Use braces or supports if necessary.

2. Introduce Gentle Movement: As tolerated, begin moving the affected area to maintain mobility.

3. Mindful Use of Ice: Apply for short durations if it helps with pain, but avoid excessive use.

4. Compression and Elevation: Continue to manage swelling.

5. Seek Professional Guidance: A healthcare provider can offer personalized advice and interventions.

Conclusion

While the RICE method has been foundational in acute injury management, modern approaches emphasize the importance of early, optimal loading and a more nuanced understanding of the body’s healing processes.

We recommend using the PEACE and LOVE method to our clients.

Chiropractic care aligns with these contemporary methods, focusing on individualized treatment plans that promote natural healing and quicker return to activity.

If you’ve recently experienced a sprain or strain, we’re here to help you navigate your recovery with the most up-to-date strategies.

Contact our office today to schedule an appointment and take proactive steps toward healing.

Your recovery is our priority. Let’s work together to get you back to your active lifestyle safely and efficiently!

Reference Articles:

1. Revisiting the Use of Ice in Acute Injury Management

Reference:

• Bleakley, C. M., Glasgow, P., & MacAuley, D. C. (2012). Price needs updating, should we call the POLICE? British Journal of Sports Medicine, 46(4), 220-221. doi:10.1136/bjsports-2011-090297

Summary:

This article introduces the POLICE protocol—Protection, Optimal Loading, Ice, Compression, Elevation—as an evolution of the RICE method. The authors argue that while rest is important, early mobilization through optimal loading can promote better tissue healing and functional recovery.

2. The Inflammatory Process and the Use of Ice

Reference:

• van den Bekerom, M. P., Struijs, P. A., Blankevoort, L., Welling, L., van Dijk, C. N., & Kerkhoffs, G. M. (2012). What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? Journal of Athletic Training, 47(4), 435-443. doi:10.4085/1062-6050-47.4.14

Summary:

This systematic review examines the evidence supporting each component of the RICE protocol. The findings suggest that while compression and elevation have beneficial effects on reducing swelling, the evidence for rest and ice is less conclusive. The authors highlight the need for more research to validate the efficacy of ice in the healing process.

3. Introduction of the PEACE & LOVE Protocol

Reference:

Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine, 54(2), 72-73. doi:10.1136/bjsports-2019-101253

Summary:

This article presents the PEACE & LOVE protocol as a contemporary approach to managing soft tissue injuries. The protocol emphasizes the importance of patient education, avoiding anti-inflammatory medications, and incorporating early loading and exercise to facilitate optimal recovery.

4. The Role of Inflammation in Healing

Reference:

Tseng, C. Y., Lee, J. P., Tsai, Y. S., Lee, S. D., & Kao, C. L. (2013). Topical cooling (icing) delays recovery from eccentric exercise–induced muscle damage. Journal of Strength and Conditioning Research, 27(5), 1354-1361. doi:10.1519/JSC.0b013e318267a22c

Summary:

This study investigates the effects of icing on muscle recovery after exercise-induced damage. The results indicate that icing may delay the natural inflammatory response necessary for muscle repair, suggesting that the routine use of ice could impede the healing process.

5. Early Mobilization vs. Immobilization

Reference:

• Hoffman, M., & Martin, B. (2018). Treatment of ankle sprains: a systematic review. Clinical Sports Medicine, 37(2), 351-362. doi:10.1016/j.csm.2017.12.008

Summary:

This systematic review compares the outcomes of early mobilization versus immobilization after ankle sprains. The findings support early mobilization to enhance functional recovery and reduce the risk of recurrent injuries.