RICE is a

mnemonic A mnemonic ( ) device, or memory device, is any learning technique that aids information retention or retrieval (remembering) in the human memory for better understanding. Mnemonics make use of elaborative encoding, retrieval cues, and image ...

acronym An acronym is a word or name formed from the initial components of a longer name or phrase. Acronyms are usually formed from the initial letters of words, as in ''NATO'' (''North Atlantic Treaty Organization''), but sometimes use syllables, as ...

for the four elements of a treatment regimen that was once recommended for soft tissue injuries:

rest Rest or REST may refer to: Relief from activity * Sleep ** Bed rest * Kneeling * Lying (position) * Sitting * Squatting position Structural support * Structural support ** Rest (cue sports) ** Armrest ** Headrest ** Footrest Arts and enter ...

, ice, compression, and

elevation The elevation of a geographic location is its height above or below a fixed reference point, most commonly a reference geoid, a mathematical model of the Earth's sea level as an equipotential gravitational surface (see Geodetic datum § ...

. It was considered a

first-aid First aid is the first and immediate assistance given to any person with either a minor or serious illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery. It includes initial int ...

treatment rather than a cure and aimed to control

inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...

. It was thought that the reduction in pain and swelling that occurred as a result of decreased inflammation helped with

healing With physical trauma or disease suffered by an organism, healing involves the repairing of damaged tissue(s), organs and the biological system as a whole and resumption of (normal) functioning. Medicine includes the process by which the cells ...

. The protocol was often used to treat sprains, strains, cuts, bruises, and other similar injuries. The mnemonic was introduced by Dr. Gabe Mirkin in 1978. He took back his support of this regimen in 2014 after learning of the role of inflammation in the healing process. The implementation of RICE for soft tissue injuries as described by Dr. Mirkin is no longer recommended, as there is not enough research on the efficacy of RICE in the promotion of healing. In fact, many components of the protocol has since been shown to impair or delay healing by inhibiting inflammation. Early rehabilitation is now the recommendation to promote healing. Ice, compression, and elevation may have roles in decreasing swelling and pain, but have not shown to help with healing an injury. There are different variations of the protocol, which may emphasize additional protective actions. However, these variations similarly lack sufficient evidence to be broadly recommended. Examples include PRICE, POLICE, and PEACE & LOVE.

Primary four terms

Rest

Rest refers to limiting the use of an injured area. It was once recommended to rest an injury for up to 2 days or until it was no longer painful to use. It was intended to reduce inflammation and to prevent further injury. Blood supply is an important component of inflammation. By resting an injury, blood flow to the area is reduced, which reduces the swelling and pain associated with inflammation. The early stages of healing involve microscopic scaffolding that is built upon to repair an injury. These scaffolds are relatively weak until reinforced by later stages of healing. Early and aggressive movement could potentially disrupt the scaffolds, delaying healing or worsen an existing injury. Although rest may provide some benefit immediately after an injury, returning to movement early has been shown to be better at reducing pain and encouraging healing.

Ice

Ice refers to the application of cold objects to an injury, such as ice, an icepack, frozen vegetables, etc. It was meant to reduce swelling and inflammation by

vasoconstriction Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, in particular the large arteries and small arterioles. The process is the opposite of vasodilation, the widening of blood vess ...

. However, adequate blood flow is essential in allowing cells and signals from our immune system to reach injured areas. By reducing the entry of these cells and signals to the injury, healing can be delayed, or possibly inhibited. The current research supports the role of ice in temporary pain relief, but there is little evidence supporting the use of ice to aid in healing, or even swelling reduction. Further research is needed to further understand how ice should be applied. At this time, due to the lack of evidence, there is no consensus on the ideal temperature ranges, time frames, application methods, or patient populations when using ice on a soft tissue injury. Most studies use icing protocols of intermittent 10-20 minute applications, several times a day for the first few days following an injury.

Compression

Compression refers to wearing bandages,

stockings Stockings (also known as hose, especially in a historical context) are close-fitting, variously elastic garments covering the leg from the foot up to the knee or possibly part or all of the thigh. Stockings vary in color, design, and transpare ...

, braces, or similar devices to apply pressure over a localized area to reduce swelling and stop bleeding. The increased pressure pushes fluids into the blood vessels to drain away from the area. The effects of compression on swelling reduction are temporary and gravity-dependent. Although studies have demonstrated the effects of compression on swelling, there is little evidence to support the use of compression to promote healing. When considering the use of compression, the evidence supports the use of elastic bandages with Intermittent Pneumatic Compression (IPC) to reduce swelling and pain, while improving range of motion.

Elevation

Elevation refers to keeping an injury above the level of the heart, such as propping up a leg with pillows. The goal was to reduce swelling by using gravity to encourage blood return from the swollen area back to the heart. The reduction in swelling could improve pain by relieving pressure from the area. The effects of elevation on swelling have been shown to be temporary, as swelling returns when the injured area is no longer elevated. However, at this time there is little evidence to support that elevation promotes healing.

Current support

Dr. Gabe Mirkin has since recanted his support for the regimen. In 2015 he wrote: Rest may play a role immediately after an injury, but the evidence supports early mobilization to promote healing. Due to inhibitory effects of ice on mounting a proper inflammatory response, a protocol including extended applications of ice could delay the body's attempt at healing. While it is unclear what the effects of elevation and compression are on the healing process, reduction of swelling is a transient effect and returns when the injury is returned to a lower, gravity-dependent position. Currently, the RICE protocol is no longer recommended and has given way to other protocols for treating soft tissue injuries. Most recently, in 2019 the mnemonic "PEACE & LOVE" was coined by Blaise Dubois. The PEACE component stands for protection, elevation, avoid

anti-inflammatories Anti-inflammatory is the property of a substance or treatment that reduces inflammation or swelling. Anti-inflammatory drugs, also called anti-inflammatories, make up about half of analgesics. These drugs remedy pain by reducing inflammation as op ...

, compression, and education. It guides the treatment of

acute Acute may refer to: Science and technology * Acute angle ** Acute triangle ** Acute, a leaf shape in the glossary of leaf morphology * Acute (medicine), a disease that it is of short duration and of recent onset. ** Acute toxicity, the adverse ef ...

soft tissue injuries. The LOVE component stands for load, optimism, vascularization, and exercise. It guides the treatment for the sub-chronic and chronic management of soft tissue injuries.

Variations

Variations of the acronym are sometimes used to emphasize additional steps that should be taken. These include: * "PRICE" – Protection, Rest, Ice, Compression, and Elevation * "POLICE" – Protection, Optimal Loading, Ice, Compression, and Elevation * "PEACE & LOVE" – Protection, Elevation, Avoid Anti-inflammatories, Compression, Education & Load, Optimism, Vascularization, Exercise

References

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