Rest, Ice, Compression and Elevation Soft Tissue Injury First Aid

Treatment Tips for Immediate Sports Injury and Soft Tissue Injury First Aid


If you suffer an injury such as a sprain, strain, muscle pull, or tear, immediate first aid treatment can prevent complications and help you heal faster. One of the most popular acronyms to remember if you get a sports injury is RICE, which stands for Rest, Ice, Compression and Elevation. Using these immediate first aid measures is believed to relieve pain, limit swelling and protect the injured soft tissue.


Soft Tissue Injuries

When an injury occurs the damaged soft tissue may bruise, swell or bleed (externally or internally) and become inflamed. Healing occurs as the damaged tissue is replaced by collagen, perhaps better known as scar tissue. In most cases the tissue needs complete repair before you should return to sports.


Does Ice Delay Healing?

In 2010, a study was published that questioned the use of ice on acute injuries. Professor Lan Zhou lead a team at the Neuroinflammation Research Center at the Cleveland Clinic in Ohio who found that inflamed cells produce IGF-1, (insulin-like growth factor-1), a hormone which increases the rate of muscle regeneration and helps heal damaged tissues. Their small study conducted on mice found that icing muscle injuries prevented the release of IGF-1. The study authors concluded that applying ice to reduce swelling, may actually delay healing of soft tissue injuries. The study has sparked debate in the medical community about the benefits and limitations of managing inflammation as a method of encouraging healing. Gerald Weissmann, the editor of the journal that published the study was quoted in the Telegraph saying “For wounds to heal we need controlled inflammation, not too much, and not too little. It’s been known for a long time that excess anti-inflammatory medication, such as cortisone, slows wound healing. This study goes a long way to telling us why – insulin-like growth factor and other materials released by inflammatory cells helps wound to heal.”


At present, the RICE treatment approach is still being recommended by most experts, although many are waiting for further research to help sort out the controversy. Some in the field have begun to change treatment recommendations for acute soft tissue injuries to include only Rest, Compression and Elevation (RCE), but no ice.


The RICE Method of Acute Injury Treatment

  • Rest: If you are injured, stop playing, get medical attention if necessary and rest. Immediately resting after an injury is important for two reasons. First, rest is vital to protect the injured muscle, tendon, ligament or other tissue from further injury. Second, your body needs to rest so it has the energy it needs to heal most effectively.


  • Ice: If you are using ice, choose a cold pack, crushed ice or a bag of frozen peas wrapped in a thin towel to provide cold to the injured area. An ice massage is another extremely effective way to direct cold to the injured tissue.


Cold provides short-term pain relief and also limits swelling by reducing blood flow to the injured area. As stated above, it’s unclear if reducing inflammation entirely is helpful or harmful as it relates to tissue repair and healing times. If you choose to use cold therapy, never apply ice directly to the skin (unless it is moving as in ice massage) and never leave ice on an injury for more than 20 minutes at a time. Longer exposure can damage your skin and even result in frostbite. A good rule is to apply cold compresses for 15 minutes and then leave them off long enough for the skin to re-warm


  • Compression: Compression helps limit and reduce swelling, which may delay healing. Some people also experience pain relief from compression. An easy way to compress the area of the injury is to wrap an ACE bandage around the swollen part. If you feel throbbing, or if the wrap just feels too tight, remove the bandage and re-wrap the area so the bandage is a little looser.


  • Elevation: Elevating an injury help control swelling. It’s most effective when the injured area is raised above the level of the heart. For example, if you injure an ankle, try lying on your bed with your foot propped on one or two pillows.


After a day or two of RICE (or RCE) treatment, many sprains, strains or other injuries will begin to heal. But if your pain or swelling does not decrease after 48 hours, make an appointment to see your primary care physician or go to the emergency room, depending upon the severity of your symptoms.


Once the healing process has begun, light massage may reduce the formation of scar tissue, and improve tissue healing.


Gentle stretching can be begun after all swelling has subsided. Try to work the entire range of motion of the injured joint or muscle, but be extremely careful not to force a stretch, or you risk re-injury to the area. Keep in mind that a stretch should never cause pain.


Heat may be helpful once the injury moves out of the acute phase and swelling and bleeding has stopped. Moist heat will increase blood supply to the damaged area and promote healing.

Finally, after the injury has healed, strengthening exercises can be begun. Start with easy weights and use good form.


It’s helpful to work with your physician or a physical therapist as you begin injury rehab. Expert guidance can help you progress quickly, without overdoing it. Your best option is to choose a rehab expert who has experience working with athletes and is familiar with your sport.