RICE
Acute Soft-Tissue Injury Management
The classic sprain protocol — first 48-72 hours.
Memory aids matter when a sprained ankle walks in and the question is what to send the patient home with. RICE — Rest, Ice (20 minutes on, 40 off, for 24-48 hours), Compression with an elastic wrap, Elevation above heart level — is first-line for the acute phase of soft-tissue injury. NSAIDs help with pain but evidence for accelerated healing is mixed and some current literature pushes back on prolonged ice and immobilization (PEACE & LOVE protocol). AANP boards still tests RICE as the standard initial counseling, plus return precautions and a follow-up plan if symptoms persist beyond 5-7 days. Pair with Ottawa rules to decide on imaging.
- RRestAvoid weight-bearing or aggravating motion.
- IIce15-20 min every 2-3 hr; wrap, don't apply directly to skin.
- CCompressionElastic wrap; not too tight — check distal pulse and cap refill.
- EElevationAbove heart level to reduce edema.
Clinical Context
Traditional first-aid approach for acute sprains, strains, and contusions. Some contemporary teaching has moved toward PEACE & LOVE (Protection, Elevation, Avoid anti-inflammatories, Compression, Education + Load, Optimism, Vascularization, Exercise) — RICE is still most commonly tested and used in urgent-care settings.
Skip RICE if the injury is severe (inability to bear weight, suspected fracture) — image first with Ottawa ankle/knee rules. NSAIDs are widely used but may slow tendon and muscle healing; evidence is mixed. AANP often gives a twisted-ankle stem and asks about initial management.
Related Mnemonics
- Ottawa — Ottawa Ankle & Foot Rules (Imaging Decision)
Sources
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