Are we really helping by using ‘RICE’ in First Aid?

It’s been the golden rule for muscle and joint injuries for almost thirty years. The ‘RICE’ acronym (Rest, Ice, Compression, Elevation) is a common subject of our first aid classes, and many of our students who have never even taken a first aid class come in the door with this as common knowledge. However, Dr. Mirkin, the physician who coined the term, now kind of wishes that he hadn’t. 

As he describes it, it all boils down to inflammation. When we are sick, the body responds by sending inflammatory cells to the area to stimulate healing. The same happens with muscle injuries. We use ice to reduce swelling right after an injury occurs, but by doing so we are hindering those inflammatory cells from getting where they need to be, and in turn slowing down the healing process. When we teach students to use an EpiPen auto injector, ice is pretty much contraindicated due to the vasoconstriction that would stop the drug effectively running through the body. Here we see the same argument but with our natural immune response. 

Old habits die-hard and it has become an area of contention. Although everyone still agrees ice is effective to reduce pain immediately after an injury, it’s maybe not the best practice to still be using it several hours after the injury occurred. First Aid and emergency medicine is going through a huge revolution at the moment. We should never get complacent with golden rules just because ‘that’s…the way I’ve been taught’. Hopefully we will see some more studies on this issue and who knows, RICE may eventually become a thing of the past!  Dr. Mirkin’s full write up can be found here.

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