Moving into winter sporting season, many of us will find that at some point or another we will turn to the trusty old R.I.C.E (Rest, Ice, Compression, Elevation) regime to get us through our weeks.
As a lot of athletes, gym go-ers and weekend warriors know, the R.I.C.E regime has long been recommended to assist with symptom management following an acute injury. The four components are designed to avoid further injury or irritation, reduce blood flow to the injured area, reduce pain, and limit swelling, thus aiding a quick recovery.
As the R.I.C.E regime is often self-administered, referral (sometimes added as the second “R” – R.I.C.E.R) is often bypassed, and as such, the R.I.C.E regime is often left open to interpretation. It is not uncommon to come across people who have left ice on for so long they have sustained themselves an ice burn and been unable to take a hot shower for weeks after! Or thought that one day of rest following an ankle sprain was adequate, and promptly returned themselves to marathon training the next day. By far however, it is the Rest component of R.I.C.E.R that when self-interpreted often causes the biggest delays in recovery. This is not because people are not taking enough rest, but because they are taking too much rest!
Damaged tissues in our bodies require mechanical load to assist in tissue regeneration and healing. Mechanical load is anything that stresses that tissue. For example, ankle movement, calf stretching, walking, running, jumping, or any other activity involving the legs will load a calf muscle. Sure, some period of rest is necessary following an acute injury, but it is not as long as some may think. Research shows that up to 24 hours of rest following an injury to soft tissue (ligaments, tendons and muscles) is adequate to allow the initial healing to begin. Following this, the tissues should be gradually loaded to optimise the healing process and ensure that structure regains its length and strength as soon as possible. This means that following an ankle sprain, you may stay off your feet for that day, but the next day you should start to move the ankle and walk as you are able! The exception is bone, which in a lot of cases may require an extended period (weeks) of immobilisation to ensure healing occurs optimally. But even following a fracture, after the initial rest period is over loading that bone is the single most important thing you can do to ensure that bone returns to its pre-injury strength and resilience.
As our understanding of injury and tissue loading has developed, so has the R.I.C.E regime. Our recognition of the importance of load and the detrimental effects that too much rest can have on our tissues has lead to the development of the P.O.L.I.C.E.R principle, in the hope that we can aid in as efficient and effective a rehabilitation as possible for those who are injured.
What is P.O.L.I.C.E.R?
P – Protect
We have started to move away from using the word rest, because rest means different things to different people. Instead, we encourage people to protect the injured site for a short period of time. Sprained your ankle? Then limit how much walking you do to protect the injured tissues there. Dislocated your shoulder? Perhaps wear a sling for a day or two to help you carry the weight of your arm and not irritate the joint further. Protecting means doing as much as you are able without increasing pain and swelling at the injured site either at that time, or the next day.
O – Optimally
L – Load
As we have come to understand the importance of load in injury recovery, we now talk about “Optimal Loading”. Optimal loading might mean taking a short walk a day or two after an ankle sprain. It probably doesn’t mean going out for a 5km run though – there is of course such a thing as overload. Optimal loading will depend on the type of injury, the severity of injury, and each individual’s recovery rate.
I – Ice
Ice is still recommended as it reduces blood flow to the area, limiting secondary bleeding and tissue death in the area of injury, as well as slowing down nerve impulses to give pain relief. Recently some have argued that ice reduces inflammation and may therefore be detrimental to the recovery process. However, ice has a relatively superficial effect at the injury site, and whilst it is effective in limiting swelling and reducing pain, it will do nothing to interfere with the body’s inflammatory and healing processes, so we get the best of both worlds!
C – Compression
Compression assists in limiting blood flow and swelling in the area, which may in turn assist with maintaining some flexibility of the injured limb and keep pain levels down.
E – Elevation
Similarly to Compression, elevation assists in limiting fluid build up and blood flow, and can assist in the drainage of accumulated fluid throughout the day.
R – Referral
Referral is the component of every regime that is usually forgotten. Early referral to a health professional means you get the right advice for your injury and ensure that you recovery as effectively and efficiently as possible.
So next time you find yourself with a tear, strain, sprain or twist, and you’re asking yourself “To rest or not to rest?” – remember, there really is no question!
