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Should You RICE Your Injury?

Should You RICE Your Injury? 1920 1080 ResilientRx

Most of us at some point in our lives have probably sprained an ankle or twisted a knee, and were inevitably given the advice to “RICE” (Rest, Ice, Compression, and Elevation). We’ve also been advised to take anti-inflammatory medications such as ibuprofen. This has been the go-to self treatment for minor injuries for as far back as many of us can remember. However, this method has evolved into something different, the details of which may surprise you.

Based on some newer research, the RICE method may not be the most effective way to treat acute musculoskeletal injuries. In place of RICE, the new proposed acronym is PEACE and LOVE: Protection, Elevation, Avoid Anti-Inflammatories, Compression, Education and Load management, Optimism, Vascularization and Exercise. This updated approach offers more detailed guidance, which we outline below.

Protection

This involves taking steps to prevent further injury and reduce pain. Options such as bracing, taping, or crutches will limit range of motion and deload the affected area, to allow things to calm down as the healing process begins. Outside of assistive devices like the ones listed above, protection also entails scaling back or temporarily refraining from activities that may irritate the injury such as sports or certain exercises. It is important to note that protection does not mean complete inactivity or bedrest as we will discuss a little later in the process.

Elevation

Elevation of the affected area is still a key part of early injury recovery. Elevating the region helps to reduce swelling and pain, which helps facilitate the body’s healing process. It is recommended that the injured area be elevated above the heart whenever possible to promote blood flow and reduce swelling.

Avoid Anti-Inflammatory Modalities

The advice to take anti-inflammatory drugs such as ibuprofen has long been coupled with the RICE method. The PEACE and LOVE approach advises against this, specifically with higher doses and longer duration of use  This is because the various phases of inflammation activate white blood cells that initiate tissue healing and repair (neutrophils and macrophages, for example). If possible, it may be beneficial to avoid anti-inflammatories such as ibuprofen, to allow your body’s natural processes to do their job. This also includes the use of ice. We believe that ice can certainly be useful for pain relief, but prolonged and excessive use with the intention to reduce inflammation, is not ideal because it has the potential to delay or disrupt revascularization and the arrival of those tissue-healing white blood cells. Use ice sparingly for pain management and try to wean off quickly.

Compression

Compression, like elevation, has remained an important component of early injury management. Compression helps to manage excessive swelling of the joints and hemorrhaging (bleeding) that has occurred in the soft tissue. It can provide general support to the injured area which may make it more comfortable to start moving and weightbearing, further facilitating the healing process. Compression should be applied gently and not be too tight, as excessive pressure can impede blood flow and cause some discomfort.

Education

Unlike the RICE method, which simply recommends rest, the PEACE and LOVE approach emphasizes the importance of active recovery strategies. It is important to understand the role of early movement and not rely excessively on passive modalities. Things like manual therapy and electric stim can be useful in reducing pain and swelling, but they should be used as supplements to exercise and load management. Education also entails encouraging the individual to avoid the mindset of “needing to be fixed” which can lead to overtreatment, and instead empowers them with knowledge and clear expectations for recovery.

Load Management

For nearly all patients with musculoskeletal problems, an active approach that includes movement and exercise is beneficial. Mechanical input (load, weightbearing, etc.) should be encouraged as early as safely possible along with resuming normal activities as soon as possible. Optimal loading means we are engaging and using the affected area without exacerbating pain. This promotes tissue repair and tolerance, which leads to restoring the individual’s function as a whole.

Optimism

Injuries can impact all aspects of a person’s life, including their mental health. Maintaining a positive outlook and belief in one’s ability to recover can have a significant impact on the healing process. Research has shown that patients who are optimistic about their recovery tend to have faster and more complete recoveries. There can be many mental and emotional barriers to recover, especially for someone who leads an active lifestyle. Don’t ever be afraid to ask for help or talk to someone if you are ever dealing with depression or fear after an injury.

Vascularization

Vascularization, or promoting blood flow to the injured area, is also crucial in the PEACE and LOVE approach. Blood flow helps to bring oxygen and nutrients to the injured area, which are essential for the healing process. The previously mentioned strategies of elevation, compression and load management can help promote vascularization. Even moving parts of your body that are uninjured are helpful throughout the recovery process. Another very important strategy that will promote vascularization is exercise, which is discussed next.

Exercise

Last, but certainly not least, is exercise. Exercise is crucial for a number of reasons, from promoting blood flow and swelling reduction, to strengthening the muscles and joints around the injured area – all of which lead to improved function and less pain. It is important to consult with your physical therapist or physician before starting any exercise program, as the type and intensity of exercise will depend on the specific injury and the stage of recovery.

We feel that compared to the traditional RICE method, PEACE and LOVE is more beneficial because it provides more detailed guidance when recovering from injuries, promotes a more active recovery approach, and creates an advantageous environment for the body’s natural processes to perform their duties.

Here are some additional quick tips:

  • Ice is still okay to use, especially if it helps reduce pain. We just may not need to ice for extended periods of time, multiple times per day after an injury. Your time is better spent moving within your tolerance, even if it’s not the directly injured area early on. Use ice sparingly and try to wean off as quickly as possible.
  • When the goal is pain reduction for non-acute injuries, either ice or heat is fine to use – whichever you find more soothing.
  • Pain-free aerobic exercise should be initiated within several days after a musculoskeletal injury if possible, to promote blood flow and boost mental/emotional well-being. When in doubt, always ask your PT or other healthcare provider

For ankle sprains in particular, consult with your physical therapist or other healthcare provider if you have any questions on whether or not you will need an Xray. Here are some helpful tips from Dr. Nick’s Instagram!

If you have a new or nagging injury or are not sure where to start, book a FREE discovery session (in person or virtual) with one of our Doctors of Physical Therapy!

References:

Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British journal of sports medicine, 54(2), 72-73.

Please note: The content in this blog is intended for educational purposes only and is not medical advice. See a healthcare professional if you have any questions about your individual needs.

How We’re Different

How We’re Different 1080 1080 ResilientRx

We’re ResilientRx- a physical therapy practice here in Austin Texas. We’ve helped hundreds of people just like you get back to doing what they love to do- while keeping them away from pain medication or surgery.

We’d like to take a moment to tell you how we’re different than your typical physical therapy practice. First, we need to take a look at how traditional PT clinics are run.

Traditional Physical Therapy

Traditional, “big box” physical therapy clinics that accept health insurance are very common in our healthcare system. Most clinics in the United States that accept insurance are designed to accommodate a high volume of patients, in order for the business to stay profitable.

The big reason these PT clinics need to see a high number of patients is because the amount that insurances reimburse these clinics for their services is often low and inconsistent.

So what tends to happen is your case is assigned to a physical therapist who can be double, triple, or quadruple booked.

They are managing multiple patients and other responsibilities all at once, which requires the use of Rehab assistance or technicians. 

Working with Rehab Assistance or Techs

Techs will spend anywhere from 30-40+ minutes with patients while the supervising physical therapist cycles through their patients for the hour, perhaps spending only 10-20 minutes with each of them.

Technicians are often high school educated with “on the job training” who hold no professional license or advanced clinical training.

Let’s think about that for a second…

The bulk of your direct care is in the hands of someone who is not a formally trained healthcare professional. Even under the watchful eye of the physical therapist in a busy clinic setting, is this something you feel you should be paying for and are comfortable with? We sure don’t think so.

Less direct care, more cost over time

What this system results in is that patients spend less time receiving direct skilled care, which usually means that more visits are required to get them feeling better and meeting their goals. 

And more visits means more cost to you in the long run, even if you have a copay.

Most patients will attend at a frequency of 2-3 times per week.

That’s 3 hours of PT per week, not counting the driving and waiting room times.

And even if you have a low-ish copay, that adds up quick.

How we’re different

Here’s where we are different: At ResilientRx, it’s just you and your Doctor of Physical Therapy. That’s it. 

No unskilled providers and no other patients sharing YOUR time.

The majority of our clients only attend PT once a week. Because you have one on one skilled care for a full hour, our treatments are more efficient and client-specific. 

You are making the effort to be here, investing your time and money to get better. Therefore we feel it is YOUR hour, not to be shared by anyone else, and to be fully customized to YOUR needs.

We offer high-quality, customized treatments and leave the filler stuff out

That means, no generic exercise sheets, no annoying egg timers going off telling you when it’s time to stop an exercise, and no more wasting time on things you can easily be doing at home. 

This may sound like a bad business model (trust us, it’s not)…but our goal is to work ourselves out of a job -to get you better as quickly as possible.

We make it easy too!

We will provide a structured plan for you, but also provide you the flexibility needed in scheduling. Life get’s hectic outside of physical therapy – we get it. We’ll meet you wherever you are at and come up with what works best for you!

Our goal is to provide you with the highest quality experience,  using a modern, evidence-based approach. 

Come experience for yourself, why we’re different.