RICE is changing

I'm not talking about the stuff you get from the local Chinese, or Indian take-away. No, this is a first aid blog (mostly) so I must be talking about soft tissue injuries.

For years people have been saying RICE or Rest, Ice, Compression and Elevation is the best way to treat things like pulled muscles, sprains and strains. The thing is, why? I have often wondered why we do this. Those of you that know me well enough will know that I'll never just teach something because "that's the way it's been done for years" after all, who decided on this method of treatment and why? Is there a better way of doing things? Questions, questions, why so many questions? (There's another one) For a start, if nobody ever asked questions, nobody would ever learn anything, nobody would find anything new and things would never be improved upon. If nobody ever asked, "what's that big light in the night sky?" then Neil Armstrong would never have walked on it. Oh, hang on, I've gone all astronomical, and that's a different blog. Suffice to say, I'm an inquisitive soul who just wants to make sure he is teaching what is right, and when offering first aid, then giving the best treatment possible.

So why RICE? Let's take a closer look.

Sure if something hurts, you don't want to move it, you need to reduce the activity that caused the injury in the first place, because you don't want to injure it any more than you have already. The trouble is, let's say you need to 'rest' for around six weeks, then that muscle is going to waste away. So we need to keep you moving around, ask any physiotherapist. Stay still and you're not going anywhere, not getting worse, but not getting better either. So move the injury safely, because the correct type of movement will actually stimulate the tissues to repair themselves.

Everyone does it don't they, even if they don't know why, everyone else is doing it so it must be right, right? Is it? Let me explain what ice does to human tissue. Have you noticed how when you're cold, the colour of your fingers changes, they're not as pink as usual, things may even seem to go blue, the same shade as that blue ink cartridge, that's right the Cyan one. In fact, why do you think blue lips and fingers is called Cyanosis? Cold makes your blood vessels constrict, forcing more blood to your core, where all the important bits are, like your heart and lungs for example. So if cold makes things constrict, it's going to slow or even stop the swelling process. Swelling is a bad thing isn't it? What do you think is causing that swelling, it just so happens that it could be 'good swelling' and it is your bodies defence system, rushing in to start fixing the damage. So technically, if you slow down the rush of these 'fixer cells' you're going to slow down the rate at which things get fixed. (Am I making sense?) Swelling will go away naturally when the 'fixing' has been done. Your body cleans up it's own mess, just like a good wild camper, it'll leave no trace whenever possible, sometimes 'footprints' are left behind, but you'd know these as scars, or scar tissue. So do we stop using ice altogether, or keep using it? The answer is... keep using it, but as pain relief. Use ice for no more than ten minutes immediately after an injury, then take it off for 20 minutes to half an hour, before repeating the process maybe once or twice more, but no longer than that. Putting ice on an injury that happened two days ago is a nonsense. You are decreasing blood flow, actually slowing the healing process and could be causing permanent damage to nerves.

The idea behind this is that it can reduce internal bleeding, just as applying pressure to a cut will (hopefully) stop external bleeding. This has the knock on effect of also reducing swelling. But why is this different to the swelling above? This time, the swelling is caused by whole blood leaking into surrounding tissue. If you ever get hit in the face, and get a black eye, did you notice the swelling, did you see the colours changing? Bruising or a contusion can be reduced by 'gentle' application of pressure. However hard I try though, it's difficult to find actual evidence to say whether compression helps or hinders healing. So until I find otherwise, I'll keep teaching it, but with these cautionary words of advice. Not too tight, as we don't want any further swelling to cut off the supply of blood to any tissues beyond what has now become a tourniquet.

Again, just as if you were treating a severe bleed, elevate the injury to slow down blood loss, or in this case, unwanted 'bad swelling'. Not to be confused with the afore mentioned 'good swelling'. So again, until I say otherwise, please continue to sit down with your feet up. But not for too long OK!

So what have I changed, what do I do differently now I have done my research into the RICE saga?

I have changed RICE to MICE

Move safely and limit exercise until healing is complete (NB Limit, not Stop)
Ice, but with caution and not for too long (10 on 20 off, repeat once or twice)
Compression but not too tight
Elevation, but not for too long, get it moving carefully



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