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.
Discuss this article
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
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
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
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
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