R.I.C.E. to Control Inflammation

Posted On: April 8, 2020

I have been using ice as an anti-inflammatory measure on patients for years. I remember teaching Highland Park tennis players and golfers how to ice multiple injuries — injuries like tennis elbow, rotator cuff strains and ankle sprains. As a chiropractor, I have used ice on lower back sprains and cervical strains. You name the body part and, chances are, I have used ice on it.

There is, however, a right way and a wrong way to use ice. A lot of people have heard the acronym of R.I.C.E to combat inflammation. This stands for rest, ice, compress and elevation. This works well on the extremities because it’s easy to apply this rule to arms and legs.

Rest should be relative. If you rolled your right ankle and sprained it. You need to limit movements going sideways to the right, but not necessarily forward motion. Of course this depends on the severity of the sprain. Wearing an ankle stirrup strap will give you a degree of protection sideways but will allow you to still move forward.

Ice should never be applied directly on the skin, but wrapped in cloth or paper towel to protect the skin from ice burns. How long one applies ice depends on the size of the body part. Larger parts need longer periods of ice to cool them down. A typical time for lower back pain would be for 15-20 minutes. An elbow may be 5-7 minutes. A knee and shoulder around 10 minutes. Larger people need to ice a little longer.

Rarely is there any side effect from using ice, but they can occur. Most are from user error. Improper wrapping that allows the ice pack to directly touch the skin can freeze the skin, causing an ice burn. Leaving ice on for too long can cause the extremities to swell (Hunting Response). Every now and then someone is allergic to ice and gets hives (Ice Urticaria) so anyone who experiences this should not use ice.

Compression can be as simple as an ace bandage wrapped around the body part. Again, this is easy to do with a wrist, elbow, ankle or knee and harder to do with a shoulder or lower back. There are commercially sold sleeves for shoulders and other body parts. How long should you compress? For a a couple of weeks or until the inflammation goes away.

Elevation is easy with the extremities. Simply elevate it above the level of the heart. It’s a lot harder to do with a lower back injury. Everything except the lower back should be elevated if possible.

With most injuries the inflammation will calm down in two two three days, but sometimes it lasts two weeks. It really depends on how severe the injury and how aggressive you were with using the principle of R.I.C.E. early in the injury. Early on, you can ice intermittently throughout the day. Apply the ice for as long as appropriate for the body part’s size, then remove it for a similar amount of time. Repeat this process while elevating and compressing the part.

R.I.C.E is a tool that every active individual should have in their tool kit to help them get back into action. If the principles aren’t working, consult with a knowledgeable chiropractor or physical therapist.

Stay well and stay active.

Dr. J