PRICE: Protection, Rest, Ice, Compression, and Elevation for Acute Injuries

RICE (sometimes PRICE) protocols are a standard treatment for muscle or tendon injuries. As the acronym implies, the injury should be treated with rest, ice, compression, and elevation. Sometimes protection is included as well. (P)RICE is commonly used to manage the following injuries:¹

• Sprained ankle, knee, or wrist
• Pulled or torn muscle
• Tennis elbow
• Bursitis
• Dislocated shoulder
• Tendonitis
• Head injuries

Let’s take a look at each of these treatments and examine how and why they help an injured muscle heal faster.

 

P: Protection

Protection is the first step in PRICE. Protecting the injured area means avoiding impact and trauma to the injury. This is different from rest (as we’ll see below). Where rest implies not using the muscle or tendon, protection is the act of avoiding contact. Any small impact can aggravate the already-damaged body part.

 

R: Rest

Rest is the first step in RICE (and the second step in PRICE). Rest is essential for a quick recovery from an acute injury. If you continue to use (or overuse) an injured muscle, it will take longer to heal. It may even make the injury worse.

Rest is important in the early stage of a muscle or joint injury. However, once most of the pain has subsided, exercise is also important because it helps the muscle, joint, and surrounding tissues to recover their strength and avoid becoming stiff. Building strength is important in preventing injury to the same area.

We’ll talk about exercise and physical therapy in just a little bit. First, let’s finish our discussion of I, C, and E.

 

I: Ice

Icing an injury can relieve inflammation and reduce some of the pain associated with an injury. Although this treatment has been included in the (P)RICE protocol for decades, there has been some recent controversy over it.²

Inflammation is thought to be an important part of the healing process. Thus, using ice to reduce inflammation might elongate healing for an injury.

Other evidence suggests that ice is still beneficial. One study found little difference in healing times between groups that used ice and those that didn’t. There was no difference between mobility, range of motion, and overall healing of the injury after one week.³

However, ice provides significant relief from the pain and discomfort of an injury.⁴ While it may not speed up healing, it is still beneficial for alleviating pain. And no one wants to endure unnecessary pain.

If you have an injury and you’re concerned about this controversy, feel free to skip the ice. After all, there’s no significant difference in healing time, and the overall result is the same.

When using ice on an injury, wrap the ice pack in a paper towel to avoid direct contact with the skin. In addition, you should only ice an injury for 20-30 minutes at a time. Most protocols recommend doing this several times a day for the first two days.

 

C: Compression

Applying a wrap to an injured area is compression. Compression helps to reduce some of the blood flow to the injury, reducing swelling and inflammation. Like ice, this can alleviate some of the pain of the injury. It also helps support and stabilizes the damaged muscle or tendon. Stabilizing helps to prevent overuse and misuse of a damaged muscle or joint.

When using a store-bought or homemade wrap, it’s important to regulate the level of compression. You don’t want to cut off circulation entirely. If the wrap causes pain or makes the area feel numb or hot, you should take it off or loosen it up.

 

E: Elevation

Elevation is the last step in (P)RICE. The goal with elevation is to reduce blood flow to an injury. Ideally, you should rest the injured body part high than the heart. This slows down the blood flow to that area. For example, if you sprain your ankle, you can lay down on a couch and prop your feet up. Like compression, elevation reduces blood flow just enough to alleviate pain without slowing healing.

Next Steps

(P)RICE can help to start the healing process for an injury. You can supplement a (P)RICE treatment with anti-inflammatory drugs (Advil, Tylenol, etc.) to help with the pain and inflammation.

Once the injury has begun to heal, it’s essential to start using the muscles again.⁵ If you rest for too long, you risk weakening the area, making you prone to re-injury. For example, if you injure a tendon, you’ll need to build up strength in the surrounding muscles to ensure they can stabilize the joint properly when you begin to train again.

When you being to exercise the injury, start slowly. Stop if you experience any pain or discomfort. The goal is to increase strength without irritating the injury.

 

When to See a Doctor

See a doctor immediately if the injury is severe or you think it might be infected.⁶ (An infection will have tell-tale red lines streaking from the injury.) If you have extreme difficulty moving or bearing weight with the damaged muscle or tendon, it may be a broken bone or a severely torn tendon. (Football players often suffer from ACL tears, a knee injury that typically requires surgery.)

Finally, if the injury doesn’t improve within a few days to a week, you should seek medical attention. Some injuries can take a month or longer to heal naturally; however, the pain and inflammation should decrease after just a few days.

 

Recap

(P)RICE can be an effective at-home first aid measure to treat an injured joint or muscle. It helps alleviate the pain and inflammation of the injury, allowing you to rebuild strength and stabilize the joints and muscles sooner. More severe injuries, however, require medical attention.

 

References

1. Treatment of Sports Injuries. NHS. https://www.nhs.uk/conditions/sports-injuries/treatment/#:~:text=Minor%20injuries%2C%20such%20as%20mild,example%2C%20by%20using%20a%20support. Accessed 7/11/2020.
2. Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: A systematic review of randomized controlled trials. Am J Sports Med. 2004;32(1):251-261. DOI: 10.1177/0363546503260757.
3. Bleakley CM, McDonough SM, MacAuley DC, Bjordal J. Cryotherapy for acute ankle sprains: A randomized controlled study of two different icing protocols. Br J Sports Med. 2006;40(8):700-705; discussion 705. DOI: 10.1136/bjsm.2006.025932.
4. Hubbard TJ, Denegar CR. Does cryotherapy improve outcomes with soft tissue injury. J Athl Train. 2004;39(3):278-279.
5. Rest, Ice, Compression, and Elevation. Michigan Medicine (University of Michigan). https://www.uofmhealth.org/health-library/tw4354spec. Accessed 7/11/2020.
6. Sprain: First Aid. Mayo Clinic. https://www.mayoclinic.org/first-aid/first-aid-sprain/basics/art-20056622. Accessed 7/11/20.