Injury First Aid - The RICE Method

If you get injured, you need to take immediate (and we mean immediate) action. Here's how


Posted: 30 July 2002
by Patrick Milroy

Injury is the most common reason for runners ‘retiring’ from the sport, especially as far too many attempt to run through pain without thought for the consequences. Chronic injuries – that is, long-standing ones – are invariably more difficult to restore to full health, so it should go without saying that you need to take early active intervention.

Acute injury is associated with local bleeding and that the object of first aid is to minimise this bleeding and reduce its consequences. The acronym ‘RICE’ is commonly used as an aide mémoire.

R stands for Rest – common sense, really, but a runner in the middle of a race or training session may not heed the symptoms of a less severe injury and just carry on. There may be some excuse, as exercise-induced endorphins can reduce the brain’s ability to interpret symptoms of injury, though the more experienced you are as a runner, the more intuitive you should be in interpreting these. Continuing to run will force more blood to the site of the injury and maintain bleeding – more severe damage is the inevitable result. If you have no option but to carry on, try to cool the area with water and slow right down – walking is ideal.

I stands for Ice – the application of which should be carefully controlled. Simply putting ice on the site of an injury is going to produce blistering and ice burn, so it should be wrapped in polythene, crushed and further wrapped in a damp tea towel. Time is an important factor. Fifteen minutes should be the upper limit for a single application, but this can be repeated hourly.

You can use ice in other ways during rehabilitation. Firstly, you should reapply it if you feel twinges as you gently stretch out the injury on the subsequent days, and it can also be used as a massage medium which can ease apart scarred, healing tissues while the cooling effect continues to provide capilliary contraction and prevent further bleeding. Ice is the most valuable, yet least used and understood, method of healing sports injuries.

C is for Compression, or at least counter-pressure to the bleeding capilliaries. The greater the pressure applied, the lower the amount of blood that can pass to the rest of the limb. We all apply tissues to an external cut – a bandage or Tubi-grip will have the same effect internally. However, this pressure should be less than your blood pressure – there is little point in stopping the bleeding but cutting off the blood supply to the extremity of a limb. Gangrene can still occur, so you should alternate compression with ice. If the limb goes numb, the bandaging should be released.

E reminds us to Elevate the limb. Blood pressure reduces with height – it is lower in our brain than our toes – so the higher the limb is above the heart, the less force there is within the damaged blood vessel to cause bleeding and worsen the injury. While it may not always be practical to elevate the limb, any time doing so is well spent and will aid recovery.

The RICE method (combined with anti-inflammatory drugs if desired) is the best immediate response to most injuries. Full rehabilitation requires considerable expertise, however, and we will give more details next month.


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Hi there,

Can anyone help?
I just wondered: is it true that soaking your legs in a bath of cold water (10mins) an then warm/hot water (10mins) after a run can help to prevent injuries? Or is the 10mins on/10mins off icing method the best to use? I'm finding that there is lots of different advice for this subject, and am not really sure of what to do for the best.

Cheers,
Freakette.
Posted: 11/12/2002 at 01:46

I have been running for a few years but never tried soaking in cold then hot water. Usually use ice and it seems to work. I will try and find out for you and let you know.
Posted: 12/12/2002 at 17:15

Hi Freakette, I've just started using cold water on my legs after my long runs. I manage about 10 minutes before I get bored with it and I've found it does make a difference in that I'm not as stiff the next day.

Don't know what the benefit of alternating cold then warm would be though. My Physio told me that if I've got a muscular ache I should ice it but if it's a stiff joint then I should give it heat. Maybe that's where the idea comes from.
Posted: 13/12/2002 at 03:48

Hi - I always ice my legs with cold water under the shower before turning the tap to hot after exercise, it stops any muscle soreness/stiffness developing. I read about it some years ago in an article by Jack Foster from Down Under who either holds or used to hold the over-40 world marathon best of 2hrs 11 mins. Foster said he got the idea when watching racehorses in a local stable comng in from training gallops. The stable hands always iced the horses' legs down with water hoses, so Foster took hold of the idea and found it works for humans too.
Posted: 13/12/2002 at 09:11

Help! I've just got into FLM on my 5th attempt and I have been lucky not to have any injuries before now. I pulled what I thought was a calf muscle running for the tube on the 27th Dec - it felt sore enough to make me limp a little but I have carried on training as, although a little sore, it wasn't getting worse. I couldn't do anything fast though. I've just been out for my long run and, although I was aware of the muscle, it seemed to be OK until after 20 mins when I got a type of stabbing pain at the bottom end of the calf muscle. I stopped straight away and am back home with an ice pack on it. Any idea what I have done and how to treat it please? I am terrified I'm going to lose out on my training!
Posted: 05/01/2003 at 16:32

It hopefully won't come to this, but you'll definitely have a place for next year if you do have to pull out - therre's the "ill or injured" option which guarantees you a place. All you have to do is to send in a note to this effect by the deadline - details are given in a later marathon mag.

I know what you mean though, it woul dbe gutting to have to pull out. I had to pull out last year due to an illness, and I had been really pleased with training.

I sincerely hope it doesn't come to that. I'm not sure what to suggest - I'd be inclined to get expert advice.

Best of luck with it :-)
Posted: 05/01/2003 at 17:29

dianne, the only advice i can give is to get some professional guidance. Probably best to go see a physio rather than your GP as they're more likely to understand sporting injuries.

i know what you going through, i've had a foot injury for a few weeks and the next couple of weeks will be crucial if i'm going to able to accept my FLM place. My physio is optimistic tho'.

Good luck.
Posted: 05/01/2003 at 19:24

Dear Iain and Paul,
Many thanks for your prompt replies! I will look for a physio tomorrow and hope this is short lived........... Iain, you don't say whether you are doing London this year - if you are, the very best of luck. Paul, I hope your foot injury clears up in enough time for you to be able to take up your place.

Best of luck to you both.
Dianne
Posted: 05/01/2003 at 20:14

Hi Dianne!

Yes - I am doing London on the basis of the ill or injured route, I had to pull out with a virus, but I've had a bad summer trying to shake off injuries, and I've got another virus now which is messing up my already short training. I can't help but think that I'd have done a better time last year save the virus.

Hopefully we'll all make it - good luck with the physio, one who is a runner him/herself or who has a lot of experience with running injuries is handy. Good luck to you Paul as well.

I believe Paula Radcliffe uses the ice bath thing after her training runs, so you're in good company!
Posted: 05/01/2003 at 20:27

Good luck to you all!!!

I've had laods of injury probs too last year, but I'm taking the marathon training really carefully and hopefully I'll get to the big day in one piece! We can all will each other through the painful bits and hopefully we'll have a fab time.

take it easy guys,

Freakette.
Posted: 05/01/2003 at 20:36


Ironwolf,

you're dead right. As a competitive rider who now runs, I can let you know this method (hot and cold) when used on horses is called 'hot and cold tubbing'. Simply running cold water over the legs is less alluringly called 'hosing down'.

As you correctly say hosing is used on horses coming back from hard exercise, which can be galloping on grass or even trotting on hard road, which sends shocks up a horses legs much as it does to ours. Lets face it - neither species was made to run on such hard surfaces.

I've no idea what the appropriate time would be for each hot/cold tub for people but for horses its about 20 mins per tub (ie 40 each session). Its done mainly to draw out swelling (hot) then increase drainage to move it away (cold) - so technically you should finish with cold. This is done when they've fallen over or banged their legs on a jump and are suffering from bruising/swelling.

Diane, if its the bottom of your calf muscle it could be your achilles. This really needs sorting out if its not calmed down on its own after a few days. My husband has just finished physio for exactly the same prob and is running fine now. Be careful as 'hot' is not good for tendon injuries and can cause more damage.

Good luck all. Didn't get in at London so doing Potteries instead.
Posted: 07/01/2003 at 14:04

Ironwolf,

Thanks for your reply - sorry you didn't get in but it was my fifth attempt! Apparently if you can prove 4 rejections, they eventually take pity on you! What a shame it is my unfittest year.
I have been to see a physio/osteopath- the calf feels a lot better today and he thinks it a muscle tear but I am not supposed to run on it for 10 days but go for long walks and swims instead. He used a funny machine that felt like a vibrating slendertone and when he started on my exposed bottom I was feeling a little uneasy! However, he then worked down the legs thankfully. I think he thought it could be referred pain from somewhere else but I am convinced it was localised calf pain. Anyone else had this type of treatment?
Hopefully back on the road soon!
Dianne
Posted: 07/01/2003 at 17:48

Hi All,

I will be running my first marathon at FLM this year and have upped the training runs recently. I have been getting really sore on the inside of both knees. It is ok after I warm up and during the run. But later on they get sore and stiff, particularly during the night.

Does anyone have any thoughts or ideas?

Wayne
Posted: 23/01/2003 at 15:05

I have tried the hot and cold bath thing for the past week. First impressions, it eased soreness from my calves and seems to be working. Only thing is though, need to step out of the cold bath for 2mins break at a time for fear of losing my feet and knads to frostbite (or the cold water equivalent). Was hard at first getting into the cold water, but pretty used to it now.

Jonny
Posted: 06/02/2003 at 21:48

Wayne -

Sort the problem now while it's relatively minor!! Here are some things to think about.

1) How much have you increased your mileage and how quickly? Sudden increases (more than 10% per week) in mileage and/or intensity can cause overuse injuries simply because your body cannot adapt quickly enough to the new loads it is under.

2) What shoes are you in and how long have you had them/how many miles have you run in them? If the shoe is the wrong level of support for your gait, it may disrupt instead of improve your natural biomechanics. This could lead to undue stress on the wrong muscles. For example, if you overpronate, your constantly inward rolling foot will constantly stress the inner leg muscles (which could explain the knee pain) if your shoes have insufficient support. If you're at all unsure, go to a speciallist running shop like Sweatshop and have your gait looked at with the aid of a footscan.

3) What type of surface are you training on? Running constantly on hard, unforgiving surfaces, such as pavements and roads creates huge impact levels for your legs to cope with, which increases the chance of knee pain, amongst other complaints. Try to run on grass/trails whenever possible to reduce the impact your knees have to cope with.

4) Make sure you ice any painful areas for 15 minutes after your runs, and always stretch well. Try some knee strengthening exercises when they feel better, plus some exercises to sttrengthen the surrounding muscles, as this will protect the joint itself.

Take things a bit easier till the problem is sorted and go to a physio if the problem persists after you've rested and (possibly)tweeked with an element or two of your running.

Good luck,

Freakette.
Posted: 06/02/2003 at 23:34

Can anyone give me some advice please. I'm training for my 1st FLM and training has been going well until now, mind you I'm no youngster so taking it fairly easy. During my long run yesterday, 2+ hours my upper left leg from my knee to my thigh just felt as though it has "seized" up. I stopped and walked for a while which eased the pain and stiffness but after starting to run again the pain returned. HELP anyone please what can I do.
Posted: 03/03/2003 at 10:12

BP - you say the pain/stiffness eased after you walked....could it be cramp? Do you eat or drink during your long runs? 2hrs is a long time for the muscles to work with no replenishment. Or possibly you've got a slight stain or pull in a muscle...it's hard to say exactly (I'm no doctor!!). Whatever, the initial treatment remains the same: take a few days off and ice the area for 15mins three times per day. After a gentle warm-up, stretch, taking particular notice of your thigh; do this when you get up and before you go to bed. It may be worth investing in some ibuprofen gel if you think it's a strain or pull. Ease back into your running, taking note of exactly how your leg feels. If the problem persists, go and see a physio.

Posted: 03/03/2003 at 10:39

Barbara, how long have you been running? Injuries from running this length of time(2+hrs) are not surprising.

DO NO RUN - until the injury has completely cleared up.

Follow the four step plan - RICE
1. Rest - Self explanatory really, but get loads anyway, spend as little time as possible on your feet
2. Ice - A bag of frozen peas wrapped with a tea towel being pushed against the limb
3. Compression - Use a compression sock on the injured area, but not too tight - you don't want an amputated limb!
4. Elevation - Raise your leg slightly when resting to allow toxins to drain away

Any questions on this or anything else, please ask!

Jonny
Posted: 03/03/2003 at 10:39

sorry freakette, u got there first!
Posted: 03/03/2003 at 10:40

THANKS so much Freakette and Jonny. Will definitely take your advice. I don't think it is cramp more like a strain. I've always done a bit of recreational running but only taken it more seriously since getting my place in the FLM. Have been going to gym and circuits etc for the last 3-4 years and always considered myself fairly fit until now. WOW didn't realise what hard work running is! WELL DONE to you all and thanks a million for your help. It's so nice to know there are so many lovely people out there.
Barbara

Posted: 03/03/2003 at 10:51

BP - finding running hard at the beginning is normal. Your fitness from other stuff will mean that your general strength is good and that your CV system is far superior to your running-specific muscles; I've also found this. This means a)you'll soon start to see massive improvements as your heart and lungs get even fitter; b)you have to be careful of your training load and intensity because your tendons, bones and muscles need more time to catch up and get stronger to cope with the impact of each footstrike. As a guide, I'm a fit 20yr old with a background in swimming and it took 8weeks of consistant training before running started to feel remotely 'easy', adn I still have to be reeeeeaaaally careful with my legs.

Good luck!

F.
Posted: 03/03/2003 at 11:09

happy birthday Freakette!
Posted: 03/03/2003 at 11:27

Cheers Annajo! It's not till Sunday, but for physiological purposes I'm 20!!!!

Did you have a good weekend....any races?
Posted: 03/03/2003 at 11:35

Thanks Freakette, your advice is really encouraging and I'm looking forward to it getting easier as time goes by. Can I pick your brains a bit more. I do a LOT of training at the gym and at least 4 hours a week on the treadmill as opposed to the road. Am I making a big mistake, should I be doing more on the road. My only road run at the mo is my long Sunday run. Also what to you suggest for fuelling whilst running, I take an Isotonic and Jelly Babies with me. You'll get well fed up with all my questions, sorry. Thanks so much

Barbara
Posted: 03/03/2003 at 11:43

Freakette, no races, but did a lovely easy long run through part of Richmond Park on the sunday, the sun was shining, it was a beautiful day, so still high from that! how about you, how did you do at Silverstone?

Barbara, I would say for your training on the treadmill, you will find running much easier once you start running outside more. It doesn't have to be on the road, you can go to parks or towpaths, but it is so much more pleasant running outside, rather than staring at the inside of the gym for however long you are running, which I find really mind-numbing! Fuelling-wise, it looks as though you are doing the right thing, practising with a drink and Jelly Babies, so you know you can stomach them on the day. Good luck!


Posted: 03/03/2003 at 11:54

PS Freakette, just remembered I have a birthday present for you - remember I was saying about those track spikes I was going to chuck away because they are too small for me. Ill try and get them to you and see if they fit you if you like
Posted: 03/03/2003 at 11:56

Annajo, thanks you're right, I am definitely going to run outdoors more often especially as it's a bit lighter now in the morning and evening. Your run through Richmond Parks sounds wonderful, it was such a lovely day yesterday.
Posted: 03/03/2003 at 12:02

it was amazing, the views were so good, and the weather was just right for a good run, although it got a little hot at the end (but who's complaining about that in March!) Right now, Im still in a good mood, just from remembering the run! I wish every run could be like that, but its worth waiting for one to come along every so often.

I am just going through that phase where the pace I am running at seems to be getting easier, and its a good stage to be at.
Posted: 03/03/2003 at 12:26

Yes, I know what you mean. I thought I was getting my pace just right when sadly, my leg started playing me up but with all the good advice I've received today I hope I'll be back on form soon.

My run takes me up to Blackheath and yesterday was a treat, people out enjoying flying their kites, playing football, children riding there bikes just having fun Life is good, especially when the sun shines !
Posted: 03/03/2003 at 12:34

after completeing my 20 miler last weekend i found my right shin hurting, i think it is shin splints, anyone know of a sure treatment the FLO is just around the corner.
thanks
Posted: 24/03/2003 at 20:41

Last year I tore some muscle fibres, mid inner lower leg, causing my calf muscle to contract upwards making it look bigger than the other leg. After resting for a few months and MRI scan and advice from a consultant the discomfort eased and I was running pain free again.
After months of running again it has suddenly re-occurred. Can anyone give me some advice.
Posted: 09/06/2003 at 20:57

Hi Alison,

I'm no expert, but I'll have a go till someone better comes along;-)

It could be that after you tore the fibres, you didn't do enough rehab exercises. When you tear a muscle (as you actually do but on a much, much smaller scale everytime you run), it has to 're-knit' new tissue in with existing tissue. If the muscle is not treated correctly after the injury, i.e. ultrasound, massage, stretches and strengthening exercises, scar tissue will form at the site of injury instead of the fibres regrouping smoothly. This scar tissue is much less elastic, and much weaker than ordinary muscle tissue. This means that the area is much more susceptible to future recurrance of the same injury.

Could this be the scenario with your injury? Icing for 15mins twice a day will ease the pain and promote better healing of the fibres. Some gentle calf stetches will help once you feel able to, getting progressively deeper as the calf heals. Calf and shin muscle exercises will be of a huge benefit to you, so perhaps ask a physio or thumb through some back issues of RW, as they have some great exercises for the lower leg. Definitely work hard on strengthening before you even think of running, but do plenty of other stuff that isn't aggrivating to the injury. Ease back into the running more slowly than you think you should and that'll probably be about right!!! Frustrating, I know, but it's worth sorting it now so you get consistent training later.

Hope that helps a bit;-)

F.
Posted: 09/06/2003 at 21:58

hi F,
the cool water followed by warm is to cause a state of hyperaemia or increased blood flow to the are. It des however depend on what area! and the theory is to finish in cold. the warm water and sudden influx can aid the cells required in healing and the ones that mediate this process through inflammation get to an area of relativily low vascular supply. one such example is the achiles/triceps surae tendon beneath the calf. others would benefit from just releif from inflammation such as calf and most of hamstring. The knee is simmilar to the achiles in places with naff supply and certain injuries may benifit also. Hope thats a bit of help, a reasonable sports injury or physio text is a god purchase if you always train and participate in sports. 25-40 quid will do a decent one. i'm not condoning self diagnosis for serious probs, just the chapters on home treatment and biomechanics and stuff. as if you hurt the soft tissue ice etc warm if area dictates and stretch once out of acute stage saves on bills!
regards steve
Posted: 10/06/2003 at 09:28

Hi F,
thanks for your reply. I think you are right about my lack of rehab after the injury last year, infact all I did was rest it for a few weeks. I am icing and stretching as you say, and I have an appointment for some physio and ultrasound. So I hope this time I will sort it out, I was terrified I had done something that was not going to heal.
So frustrating, my running was really improving, but I will persevere.
regards Alison
Posted: 10/06/2003 at 21:24

i find, soaking a tea towel with water and then freezing it, then applying it round the achey area works well for me, provides both ice and compression
Posted: 16/06/2003 at 22:20

Please can you help?

What is the best advise for an achillies tendon injury?  I'm in training for FLM, following a training pattern, upping the mileage sensibly and have done 5 long runs already (3 before Christmas) I aiming for a sub 3.15 time (best 3.16) and was so disappointed to retire from a race yesterday (the first time ever), which I was in fact using as a training run, as it was 26 miles over undulating country side (Belvoir Challenge, check points and food stops!)

Half way round we had to go onto road and my ankle pain dramatically increased, especially since this route started to climb.  I wasn't far from a check point, so I went back and the brilliant first aiders, especially Patrick helped out, applying 'R.I.C.E' immediately.  On returning home, I had a hot bath and have been using 'R.I.C.E.' since and Ibuprofen.

Have I been doing too many hills for too long a time?  Did the treadmill 'Raise session' from March issue RW for 4 miles twice last week.  I did feel a niggle in the week, but was able to take a rest day, without compromising on my mileage and it didn't feel too bad, as not to run on Saturday.  Just trying to build strength. Any advise would be greatly appreciated and will I get fit for FLM?  I'll be 40 next year!  Thanks Debs


Posted: 24/02/2008 at 14:16

Thanks, all, for this information. It's been verrry useful to me and my bardy leg.
Posted: 11/07/2008 at 15:52

I was surprised that there wasn't so much mention of knees.

What people did say seemed to concur with the RICE method and 'hosing down'.

I'm wondering about pre-run and during run stuff.

I have a half-marathon (RPH) and am a few weeks into training for that. However before that was rather silly and pounded the pavements attempting to get down to 20mins for 5km. To add to that I did a 20mile walk and as a consequence my left knee got a twinge on the outer left side.

This was mid-June and now a month on I've been attempting to rest it but finding myself incredibly frustrated at the recovery time.

I've switched to cross training (mainly cross trainer and doing squats stuff) to keep heart rate up and build leg strength.. but I went out for 2miles the other day and the twinge was there.. 

It isn't excruciating - which is what annoys me because I can set off without concern and then as my right shin starts to tire then I start to lock my leg a little more and then the impact on my left leg is greater and my knee can play up.
If i slow the pace RIGHT down then I can avoid this by taking longer strides - but then i go MUCH faster and for moderating myself across a training programme and doing longer distances this doesn't help me.

It seems silly to run faster and stride longer to avoid injury but could this be possible??

I'm 6' 4" and didn't really run when I was younger and now when I do anything over 10km then it's been really nice to let myself stride out as I come in to close.. but I don't want to be running full stride from the start as the pace gets too much and I don't feel much like completing over an hour's run.

It's frustrating as due to lack of experience I just don't really know what to do with my running technique as sometimes I'm fine going much further much faster and then others shins and knee kick in really early.
There is a science to it but I'm too close to the race to still be experimenting..

My thought is that I may be holding back and that meaning I am heel striking on my shorter runs and thus counter intuitively should run faster.
The first real sense of injury was when I was doing a 5km with a BIG downhill in it and I think on my second lap I jammed against a locked knee rather than allowing gravity to take me down.

A fraidy cat runner methinks.

Any thoughts?
Posted: 22/07/2011 at 14:40

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