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  • Q&A with Australian Health Practitioners

    I know you are meant to use RICER (Rest, Ice, Compression, Elevation and Referral) when you have a sports injury, but how much of each do you need to do??

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  • Jason Tomlinson

    Personal Trainer

    20mins on, 20mins off for ice for the first 48 hours or so. The others, like rest and elevation, can occur while you're icing. Compression can be applied during your break's from icing.

    If it is a serious injury you should go and see a doctor ASAP so they can hopefully diagnose it and give you more specific advice for your injury, or refer you to someone else.

  • 1

    Thanks

    I am a specialist sports physiotherapist with a sub-speciality in adolescents in sport (as awarded bu the Australian College of Physiotherapists in 2007). In addition … View Profile

    It depends a little on the injury.  I like to use RECIPE rather than RICER as it is in a more appropriate order based on the evidence and it doesn't sound like ice so you realise injury management is much more then ice.

    The first R stands for relative rest - this means resting the injured part, not resting in bed.  Resting the injured part can be a simple as strapping to prevent stretching or increased load on the injured structures, or it can be crutches for a more serious injury.  Your sports physiotherapist can advise you on the most appropriate form of relative rest to protect your injury and to prevent deconditioning.

    E stands for elevation and this is the next most important part of acute injury management - ideally you should have the injured part elevated all the time and the higher the better.  So if you injured yourself on Sat afternoon - elevate all weekend and then put your foot up on a chair at work/school and then continue elevating when you get home from work/school.

    C stands for compression and follows elevation in importance.  You should apply compression to the injured part all the time or as much as possible, being careful not to bandage too tight that you cut off your circulation and being careful of areas like the back of your knee where the bandage might bunch up.  Ideally you should use a stretchy bandage rather than a tubi grip so you can shape it to the area - a tubi grip is one shape and will be tightest in the thickest area of limb which is generally closer to your heart and basic physics says fluid will move from a high pressure area to a low pressure area - therefore away from your heart, which is opposite to what you want - so please your a compression bandage and make sure there are no gaps, anywhere!  A gap in the bandaging (often around the ankle bones) will allow the swelling to accumulate here and this is exactly the place we don't want swelling.  Focal compression, eg putting some additional foam around boney areas (eg in the ankle) also assists the effectiveness of compression.  Compression garment and TED stockings are an effective alternative to tubigrip as they are shaped to your limb.

    I is for ice - you will notice that it follows relative rest, elevation and compression.  This is where it should sit in importance based on the current evidence, however, far too often ice is the only component of acute injury management that is followed.  Crushed or Party Ice should be applied indirectly to the skin via a wet cloth/towel or ice & ezy for on average 20mins every 2 hrs, but smaller joints will require less icing and larger areas like the knee or thigh may require 30mins on/30mins off to get deep enough.  Blue gel packs are not recommended as they do not get cold enough for long enough and can also cause ice burns.  Frozen veges in a wet towel also work well.

    P&E stands for Pain limited Exercise as Prescribed by your Physiotherapist.  Exercise/Functional Movement is very important in the healing of injuries but it is important that the correct exercises and amount of exercise is prescribed, not moving your injured part and not putting weight through that limb can actually lead to loads of other problems, but it is also important not to move in a way that will cause more damage - this is where a physio can really help to get the balance righ.   In saying that, gentle movements of the injured part without causing pain, prior to your physio appointment, will generally be safe and will aid the healing process.  .  Physios have loads of training in sports injury and sports injury is the mainstay of many physio clinics so physios are the health professional best placed to diagnosis, treat and rehab your sporting injuries and they are first contact practitioners so you don't need a referral either.

    You should follow the RECIPE/RICER regime for the 1st 48-72 hrs after an injury and then decrease the frequency but continue the regime for the next week depending on the advice given by your physiotherapist. 

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