Rest, Ice, Compression, Elevation Research Articles

Is it the End of the Ice Age?

The use of the RICE (Rest, Ice, Compression, Elevation) protocol has been the preferred method of treatment for acute musculoskeletal injuries for decades. However, the efficacy of using ice as a recovery strategy following injury in humans remains uncertain, and there is a growing trend recommending against icing following injury. Animal models suggest that while ice can help to accelerate the recovery process, extreme muscle cooling might delay repair and increase muscle scarring. Despite the conflicting evidence, ice should not be dismissed as a potential treatment option. When considering what is known about the injury cascade, the optimal application window for ice is in the immediate acute stage following injury to reduce the proliferation of secondary tissue damage that occurs in the hours after the initial injury. Practitioners should tailor the application of ice based on the injury timeline and repair process, consistent with applications in 20-30 minute intervals within the first 12 hours post-injury. Until the evidence unanimously proves otherwise, the culture of icing injuries should remain a staple in sports medicine.

Ankle Injuries.

Ankle Injuries.

Workshop on Classroom Action Research Preparation for High School Teachers and Vocational Secondary Schools

The risk of injury can occur in all types of sports and is often experienced by athletes. Sports Injury is an injury to the muscular and skeletal system caused by sports activities. First Aid is emergency assistance to accident victims (sick) quickly and precisely at the scene before being evacuated to an expert person. In general, the management of sports injuries uses the principle of RICE (Rest, Ice, Compression, Elevation) which is always applied at the beginning of the injury before further handling. Exercising excessively and ignoring the correct rules of exercise, even bring injury that endangers himself. This wrong activity is due to heating does not meet the requirements, excessive fatigue, especially in the muscles, and wrong in doing sports movements. The most common injury cases, usually too ambitious to complete training targets or want to improve the training phase. A good coach will always pay attention to the state of the athlete from all aspects, one of which is from the physical state of the athlete. This means that the trainer knows how to manage the athlete not to get injured, and if he has an injury quickly know how to help, especially for minor injuries. However, not all coaches understand how the injury and how it helps for athletes. That is why there is a need for training in sports injuries and how to help for coaches who are expected to be used by athletes.

Pelatihan Pencegahan Dan Pertolongan Pertama Cedera Olahraga Bagi Pelatih PPLP Sumatera Barat

The risk of injury can occur in all types of sports and is often experienced by athletes. Sports Injury is an injury to the muscular and skeletal system caused by sports activities. First Aid is emergency assistance to accident victims (sick) quickly and precisely at the scene before being evacuated to an expert person. In general, the management of sports injuries uses the principle of RICE (Rest, Ice, Compression, Elevation) which is always applied at the beginning of the injury before further handling. Exercising excessively and ignoring the correct rules of exercise, even bring injury that endangers himself. This wrong activity is due to heating does not meet the requirements, excessive fatigue, especially in the muscles, and wrong in doing sports movements. The most common injury cases, usually too ambitious to complete training targets or want to improve the training phase. A good coach will always pay attention to the state of the athlete from all aspects, one of which is from the physical state of the athlete. This means that the trainer knows how to manage the athlete not to get injured, and if he has an injury quickly know how to help, especially for minor injuries. However, not all coaches understand how the injury and how it helps for athletes. That is why there is a need for training in sports injuries and how to help for coaches who are expected to be used by athletes.

Pelatihan Penyusunan Program Latihan Bagi Penderita Hipertensi Dan Diabetes Di Puskesmas Lapai Kota Padang

The risk of injury can occur in all types of sports and is often experienced by athletes. Sports Injury is an injury to the muscular and skeletal system caused by sports activities. First Aid is emergency assistance to accident victims (sick) quickly and precisely at the scene before being evacuated to an expert person. In general, the management of sports injuries uses the principle of RICE (Rest, Ice, Compression, Elevation) which is always applied at the beginning of the injury before further handling. Exercising excessively and ignoring the correct rules of exercise, even bring injury that endangers himself. This wrong activity is due to heating does not meet the requirements, excessive fatigue, especially in the muscles, and wrong in doing sports movements. The most common injury cases, usually too ambitious to complete training targets or want to improve the training phase. A good coach will always pay attention to the state of the athlete from all aspects, one of which is from the physical state of the athlete. This means that the trainer knows how to manage the athlete not to get injured, and if he has an injury quickly know how to help, especially for minor injuries. However, not all coaches understand how the injury and how it helps for athletes. That is why there is a need for training in sports injuries and how to help for coaches who are expected to be used by athletes.

The Effect of Elevation on Volumetric Measurements of the Lower Extremity

Background: The empirical evidence for the use of RICE (rest, ice, compression, elevation) has been questioned regarding its clinical effectiveness. The component of RICE that has the least literature regarding its effectiveness is elevation. Objective: The objective of this study was to determine if various positions of elevation result in volumetric changes of the lower extremity. Methodology: A randomized crossover design was used to determine the effects of the four following conditions on volumetric changes of the lower extremity: seated at the end of a table (seated), lying supine (flat), lying supine with the foot elevated 12 inches off the table (elevated), and lying prone with the knees bent to 90 degrees (prone). The conditions were randomized using a Latin Square. Each subject completed all conditions with at least 24 hours between each session. Pre and post volumetric measurements were taken using a volumetric tank. The subject was placed in one of the four described testing positions for 30 minutes. The change in weight of the displaced water was the main outcome measure. The data was analyzed using an ANOVA of the pre and post measurements with a Bonferroni post hoc analysis. The level of significance was set at P<.05 for all analyses. Results: The only statistically significant difference was between the gravity dependent position (seated) and all other positions (p <.001). There was no significant difference between lying supine (flat), on a bolster (elevated), or prone with the knees flexed to 90 degrees (prone). Conclusions: From these results, the extent of elevation does not appear to have an effect on changes in low leg volume. Elevation above the heart did not significantly improve reduction in limb volume, but removing the limb from a gravity dependent position might be beneficial.

Treatment of post-traumatic ankle ligament adhesions – case report

Ankle sprains are the most common sports injuries, but they also happen to people that do not do any sports at all. Most of them are inversion-type traumas which could harm soft tissues like lateral collateral ligaments, capsule and peroneal tendons. The vast majority of these injuries are grade 1 sprains where there is no clinical instability. Very often treatment is based on conservative protocols, i.e. RICE (rest, ice, compression, elevation), immobilization and avoiding weight bearing. Besides the above procedures, in the following period of time some modalities are planned, and there is not enough attention paid to regaining function after the acute stage. Such a conservative approach over a longer period of time should be reserved for fractures and grade 􀍗 sprains because immobilization leads to loss of proprioception and the formation of inelastic scar tissue caused by ligamentous adhesions. It takes about 6 weeks to form adhesions, and clinically those patients complain about pain, sometimes also with swelling, after some exertion. One treatment option is deep friction and manipulation of adherent lateral ligaments to break the adhesions. The aim of this paper is to show an alternative treatment option which is safer than manipulation. The authors propose the use of a shockwave therapy in combination with a home exercise stretching programme in positions reproducing the trauma mechanism to remodel the scar tissue. Additionally, there should be proprioception exercises for prophylaxis and regaining normal function.

Interest of rehabilitation in healing and preventing recurrence of ankle sprains

To assess the impact of rehabilitation on healing and recurrence rate of ankle sprain, 1year apart, 111 patients, who suffered an ankle sprain (67 men and 44 women; 17 mild sprains, 67 medium and 27 severe), were included by emergency physicians of four emergency rooms (ER) of Finistère. The physician was free to prescribe, or not, further investigations. He prescribed systematically to patients RICE (rest, ice, compression, elevation) protocol, put an ankle brace, and gave a prescription of standardized rehabilitation. The prescription was the same for the four ER. All patients were recalled to 1year. Of the 111 patients initially included, 21 patients were excluded for lack of response after three phone calls. In the end, 90 patients were assessable (56 men and 34 women), mean age 31.4±12.6years (range 15–55) at the time of initial trauma. Emergency physicians had diagnosed, initially, 16 mild sprains (17.8%), 56 medium sprains (62.2%) and 18 severe sprains (20%). Of the 90 patients, 73 patients have been rehabilitated (81.1%). Of the 44 accidents of everyday life, 31 were rehabilitated (70.5%). Of the 27 sports accidents, 25 were rehabilitated (92.6%). Of the 19 work-related injuries, 17 were rehabilitated (89.5%). There is no significant relationship between rehabilitation and no recurrence (P=0.45) nor between rehabilitation and full recovery of the ankle (P=0.59). Conclusion: We find no association between rehabilitation and prevention of recurrence, nor between rehabilitation and healing of patients. However, our study is limited by the small size of the non-rehabilitated group.

Vibration and pressure wave therapy for calf strains: a proposed treatment

Calf (lower leg) strains have a variety of treatment regimens with variable outcomes and return to activity (RTA) time frames. These injuries involve disruption of portions or the entire gastrocnemius-soleus myo-tendinous complex. Conservative treatment initially consists of rest, ice, compression, elevation (RICE). Immediately following calf injury, patients can utilize cryotherapy, massage, passive range of motion, and progressive exercise. In general, Grade I through Grade III calf strains can take up to 6 weeks before the athlete can return to training. It can also involve the loss of more than 50% of muscle integrity. Recently, vibration therapy and radial pressure waves have been utilized to treat muscular strains and other myo-tendinous injuries that involve trigger points. Studies have suggested vibration therapy with rehabilitation can increase muscle strength and flexibility in patients. Segmental vibration therapy (SVT) is treatment to a more focal area. Vibration therapy (VT) is applied directly to the area of injury. VT is a mechanical stimulus that is thought to stimulate the sensory receptors, as well as decrease inflammatory cells and receptors. Therefore, VT could be a valuable tool in treating athlete effectively and decreasing their recovery time. The purpose of this paper is to give the reader baseline knowledge of VT and propose a treatment protocol for calf strains using this technology along with radial pressure waves.

The effect of cooling on coagulation and haemostasis: Should “Ice” be part of treatment of acute haemarthrosis in haemophilia?

Repeated haemarthroses and the consequences of blood in the joint contribute to blood induced joint disease (BIJD) in people with haemophilia (PWH). Prevention of bleeding, through medical management, is the standard of care in developed countries, but is not universally available due to financial and other barriers. Ice application, as part of R.I.C.E. (Rest, Ice, Compression, Elevation) or alone, is commonly recommended as an adjunct treatment to decrease bleeding, pain, tissue metabolism, oedema, and inflammation. This article will review evidence regarding local cooling by commonly used ice application methods, to decrease the temperature of the skin and intra-articular (IA) joint space and the resultant effects on haemostasis and coagulation. The general literature was reviewed for articles in English describing temperatures achievable in the skin and IA space using clinically relevant ice protocols, and the effect of cooling on haemostasis and coagulation. The literature demonstrates that typical methods of ice application can cool both the skin and IA space. Published, general literature studies have also consistently demonstrated that experimental cooling of blood and/or tissue, both in vitro and in vivo in humans and in animal models, can significantly impair coagulation and prolong bleeding. In PWH with acute haemarthrosis, ice application has potential to increase haemorrhage morbidity by further impairing coagulation and haemostasis. Ice has not been shown to improve overall outcome, stop bleeding nor swelling from haemarthrosis. Although ice can help manage acute, haemarthrosis-related pain, there are other available interventions that will not impair coagulation and haemostasis.

The epidemiology of competition and training-based surf sport-related injury in Australia, 2003–2011

ObjectivesTo describe the epidemiology of competition and training-based surf sport-related injury in Australia in the years 2003–2011. DesignA retrospective epidemiological review. MethodsInformation on surf sport-related injuries was obtained from Surf Life Saving Australia's SurfGuard Incident Reporting Database during 1 January 2003 to 20 August 2011. ResultsThere were 2645 surf sport-related competition or training-related incidents. Males and females experienced similar proportions of injury by activity type, with older individuals experiencing a higher proportion of injuries during training than younger individuals. Minor first aid was required for 54.5% of the competition and 43.7% of the training-related incidents, with major first aid required in just over 10% of both incident types. Overall, inflatable rescue boats, beach flags, and surf boats were the most common activities performed at the time of the incident, with returning to shore and negotiating the break the most common possible contributing factors to surf boat incidents. Bruises/contusions, strains, inflammation/swelling, and sprains were the most common types of injuries that occurred during both competition and training. RICE – Rest–Ice–Compression–Elevation – was the most common form of initial treatment for the injury during both competition and training. ConclusionsParticipation in surf sports is not without risk of injury. Information from this study will inform injury prevention efforts for surf sport and act as a guide for future research in this area, and towards improved injury surveillance for surf sport-related injuries.

Treatment of skeletal muscle injury: a review.

Skeletal muscle injuries are the most common sports-related injuries and present a challenge in primary care and sports medicine. Most types of muscle injuries would follow three stages: the acute inflammatory and degenerative phase, the repair phase and the remodeling phase. Present conservative treatment includes RICE (rest, ice, compression, elevation), nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy. However, if use improper, NSAIDs may suppress an essential inflammatory phase in the healing of injured skeletal muscle. Furthermore, it remains controversial whether or not they have adverse effects on the healing process or on the tensile strength. However, several growth factors might promote the regeneration of injured skeletal muscle, many novel treatments have involved on enhancing complete functional recovery. Exogenous growth factors have been shown to regulate satellite cell proliferation, differentiation and fusion in myotubes in vivo and in vitro, TGF-β1 antagonists behave as inhibitors of TGF-β1. They prevent collagen deposition and block formation of muscle fibrosis, so that a complete functional recovery can be achieved.

Ultrasound Versus Magnetic Resonance Imaging in the Diagnosis of An Acute Hamstring Tear

A 34-year-old man presented with a left posterior thigh hematoma, swelling, and extensive bruising in the medial aspect of his left hamstrings. During a softball game a week earlier, while sprinting to the first base, he felt a sudden sharp pain in the posterior aspect of his left thigh. He subsequently experienced swelling, extensive bruising, and limitations in his functional activities of daily living, including walking and sitting, and he had a sense of weakness in the left knee. He started the rest, ice, compression, elevation (RICE) program acutely and used nonsteroidal anti-inflammatory drugs for 10 days, which led to an improvement in his symptoms, after which he started a progressive physical therapy program that included stretching, strengthening, and a gradual return to his previous activities. Upon examination, the patient had a slight antalgic gait, with a shorter step length on the affected side. Inspection revealed diffuse bruising in the medial and lateral hamstrings (Figure 1), a gap in the medial hamstrings visible with knee flexion, and decreased strength in knee flexion compared with the right side. Focal tenderness was present at the distal insertion of the left semitendinosus and semimembranosus muscles. Range of motion was full,withpainattheendofkneeflexion.Findingsofaneurologicexaminationwerenormal, other than weakness of knee flexion as a result of pain. Hamstring muscle injuries are common among sprinters, hurdlers, and long jumpers. They also occur in sports that involve sprinting, especially football and field hockey. The majority of these injuries occur in the biceps femoris muscle, mainly at the muscle-tendon junction. Hamstring injuries typically occur from eccentric overload [1,2]. Damage occurs first at the musculotendinous junction, which typically is the weakest component of the hamstring muscle [3]. Imaging studies can help fully define hamstring injuries, guide therapy, and predict prognosis. Ultrasonography (US) of this patient’s bilateral hamstrings was performed and showed tearing of the left semitendinosus and biceps femoris at the musculotendinous junction. The transverse (Figure 2) and sagittal (Figure 3) images show torn, irregular muscle edges with retraction of fibers surrounded by hypoechoic and anechoic hematoma and fluid. US increasingly is being utilized to evaluate the musculoskeletal system. US is an attractiveoptiontohelpdiagnosehamstringsinjuriesbecauseitcanbeperformedatalower cost than magnetic resonance imaging (MRI), it does not expose patients to ionizing radiation (as is the case with computed tomography), and it may be more widely available than MRI in some areas. Additional advantages of US over MRI include visualization of tendon fibers, color Doppler or power Doppler imaging, dynamic assessment, and determination of focal tenderness to sonopalpation. Early diagnosis and classification of an injury may help determine if conservative treatment or surgery is appropriate. At the time of the initial injury, US assessment has a sensitivity similar to that of MRI imaging in the depiction of hamstring injuries. MRI has been shown to be more sensitive in the follow-up evaluation of hamstrings. MRI better demonstrates the full extent of muscle strain in which the longitudinal length has a strong correlation with the time required for rehabilitation and recovery [4,5]. In other words, the size of a tear is associated with the number of days lost from competition [6]. Avulsion injury of the hamstring complex is more serious than isolated muscle strain because it necessitates prompt surgical repair. Avulsion injuries tend to occur more

Treatment For Common Running/Walking Foot Injuries

Whether you are a weekend warrior or a serious athlete, most runners fear the possibility of being injured. For those who are physically active or stand on their feet all day, healthy feet are important Highly conditioned runners spend many hours performing foot maintenance to prevent unnecessary injuries. Some of the common foot injuries are: Plantar Fasciitis, Metatarsal Stress Fractures, blisters, Metatarsalgia, Morton’s Syndrome, Turf Toe, and Sesamoiditis. Most runners realize that shoes wear from the inside out. Runners should frequently check the inside of the shoe. Attention should focus on the pads of the insole, stitching, toe, heel, and instep areas. Properly lacing the shoe strings may save wear and tear on the shoes and feet. RICE (rest-ice-compression-elevation) treatments are a very important part of healthy foot maintenance and treatment; treatments should be done sooner rather than later. Many running problems may be prevented by focusing attention on your feet. Frequently inspect ones feet before and after running or walking. Foot pain is not normal when running or walking; seek medical assistance as soon as possible. If your goal is to enjoy running for a lifetime, it is sometimes more important to use your head than your feet. If you want to run tomorrow, take care of your feet today!

Percutaneous Steroidal Treatment in Relapses of Chronic Tendinopathies: A Pilot Study

Relapses are frequently observed in subjects with chronic tendinopathies. Corticosteroid injections are usually performed with positive results, but are uncomfortable for the patient and not free from side effects. The aim of this pilot study is to evaluate the short-term efficacy and tolerability of an occlusive Betamethasone Valerate medicated Plaster (BMVP). Fifteen subjects with relapses of chronic tendinopathies (clinical and ultrasound diagnosis) were enrolled, and treated according to RICE (Rest - Ice - Compression - Elevation) protocol. An BMVP plaster was also applied on the affected tendon. Clinical examination, at baseline and after 7, 14, 21 and 28 days, included pain (VAS at rest and during activities) and functional evaluation. Local side effects on the area and drop-outs were also recorded. Pain, both at rest and during activities, significantly decreased at 28 days (from 3.7 ± 2.7 to 1.1 ± 1.7 p < 0.01, and from 7.3 ± 1.7 to 3.3 ± 1.4 p < 0.0000, respectively). Moreover, the patients reported a significant improvement in the functional limitation. Five subjects dropped out of the study. No side effects were reported. The release of the steroid in pharmacologically-active concentrations over 12 - 24 hours and the good penetration of the drug in subcutaneous tissues explain the positive results. BMVP application may be considered a reliable first therapeutic approach in relapses of chronic tendinopathies.

Recommendations of community pharmacists for the treatment of sprains and strains

Abstract Objective To determine the recommendations that community pharmacists make when treating ankle sprains and strains, in particular regarding the use of non-steroidal anti-inflammatory drugs (NSAIDs). The current debate about this issue is whether to initiate NSAIDs immediately post-injury, or withhold for the first 48 hours to allow inflammation to occur. The opposing viewpoints are that ‘inflammation is a barrier to healing’ and that ‘inflammation is vital for healing’ Method In August 2005, a structured questionnaire was mailed to 493 community pharmacies throughout New Zealand and addressed to the pharmacist. Questions covered the advice and interventions (both pharmacological and non-pharmacological) that would be given to a patient presenting with a strain or sprain, beliefs about different analgesics and their role in treatment, and information relating to their postgraduate qualifications and prevalence of sprains and strain seen in their pharmacy. Key findings The response rate was 46.5% (229), the mean number of sprains reported in a month was nine. Ninety-six per cent (219) of pharmacists recommended RICE (rest, ice, compression, elevation) as the mainstay of treatment in these types of injuries, and analgesics were recommended frequently, 89% (201). Almost half, 46% (104) of the pharmacists thought that NSAIDs should be withheld for 24–48 h post-injury, and almost half, 46% (104) did not; the remainder, 8% (17) were unsure. Conclusion Current evidence is moving away from using NSAIDs immediately post-injury to treat strains and sprains. While many pharmacists are aware of this, there are still others who are either unaware of this new research or who disagree. Most pharmacists were treating these injuries well, but pharmacists need to be aware of current recommendations to make sure that they follow ‘best practice’ and minimise further harm to their patients.

Axiom or Myth? Always X-ray and Splint Every Ankle Sprain

Axiom or Myth? Always X-ray and Splint Every Ankle Sprain

A Study of Traumatic Events in Junior Fencing Competitions

Background: Fencing is one of the oldest and most beautiful sports in the world. Nowadays due to using protective devices, Fencing is safe and injuries are rare. But physicians who are medical supervisors of fencing competitions must be aware of possible sport injuries to be able to manage them. Knowledge of fencing injuries especially in “juniors” can be very useful and profitable to design methods for decreasing risk of injuries. Methods: This survey was done during Junior International Fencing Championship (men's sabre, foil & epee), which was held in Yazd–Iran Feb 2000. 155 Fencers took part in 610 competitions. The average age of athletes was 17.88 year (SD = 1.20). Results: 31 requests for medical attention (Sabre: 20cases, Foil: 6 cases, Epee: 5cases) related to injuries were classified as follows: Injuries due to opponent's weapon 20 cases (64.5%) including 12 wounds & 8 bruises Skin abrasions & blisters on the contact site between handle & hand, 6 cases (19.3%) Functional overloading & other types 5 cases (16.1%) All the injuries were managed with RICE (rest, ice, compression, elevation) & No competition was canceled due to injuries. The most dangerous injury was on the carotid area of neck due to sharp end of a broken sabre weapon. Conclusion: The result of study emphasized that if suitable protective devices are used, youth fencing competitions bear low risk of accidents & most of sports injuries in fencing can be managed with first aids and RICE. Although the dangerous injury due to sharp end of broken weapon is rare but medical teams of fencing competitions should be aware of this accidents and Emergency facilities must be available.

The treatment of acute soft tissue trauma in Danish emergency rooms.

Rest, ice, compression, elevation (RICE) is the most recommended treatment for acute traumatic soft tissue injuries. A questionnaire was given to all Danish emergency rooms (n = 5) regarding their routines for acute treatment of ankle sprains and muscle contusions. Complete answers were received from 37 emergency rooms (73%), covering the treatment of 111 ankle sprains and 101 muscle contusions. Treatment with RICE was given in a minority of injuries, ice (21%), compression (32%) and elevation (58%) similarly between injury types. A complete RICE treatment was rarely applied (3%). Verbal information on RICE and rehabilitation was given in less than half of the cases. We conclude that the acute treatment of ankle sprains and muscle contusions in the Danish emergency rooms is not applied in accordance with consensus from international literature, and that the instruction in rehabilitation should be improved.

Diagnosis and treatment of ankle sprains.

Clinicians in ambulatory and primary care are almost guaranteed, at some point in their practice, to encounter a patient who has suffered an ankle injury. They must be prepared to diagnose, treat, and refer appropriately. By understanding the anatomy of the ankle, the health care provider will understand the mechanisms and common types of injury. By using techniques of inspection, palpation, and performing the anterior drawer and talar tilt tests, the clinician can grade a sprain accordingly, and refer for x-rays or orthopedic consultation appropriately. The principles of RICE (rest, ice, compression, elevation) are explained and different treatment methodologies for grades I to III of sprain are discussed.