RICER & No HARM

During the first 2-3 days after a soft tissue injury (muscle strain, bruise or joint sprain), appropriate first aid management aims to limit swelling and pain using the principles of RICER and no HARM.

A normal, healthy response to injury is for your body to flood the affected area with swelling.

Inflammatory juices contain neutrophils to fight infection, and help the repair process.  However swelling also contains chemicals that cause pain, and in most cases, limiting the inflammatory reaction reduces pain and reduces recovery time.


RICER  - Rest, Ice, Compress, Elevate & Refer (eg. to Physio)

Rest - Avoid activities that cause pain, for knee, leg or ankle injuries this will sometimes include weightbearing, by using crutches

Ice - 10-15mins cold causes vasoconstriction, which means that the blood vessels constrict, reducing excess blood to the affected area.  By reducing blood flow in the first 24hours, it limits bruising in the area.

The most effective time for using ice (or cold compress, a bag of peas etc) is in the first 24 hours, so icing every hour or two during this time is ideal, although it can also be helpful after that, especially where swelling or aching due to inflammation exists.  Please ensure ice is not placed directly in the skin, but instead use some wet fabric in between to avoid an ice burn.  Please be careful near sensitive areas, including genitals.. Most people don't feel comfortable icing directly near the neck or spine, so only ice if you feel it helps and you can relax.

If placing ice on a joint is particularly painful (more so that the other side), please consult a health professional, as it can be a sign of fracture, and may need further investigation.

Compress - Wearing a compression bandage or stocking around the whole affected area, also limits swelling, brusing and pain.  Please consider where swelling may drain to with the effect of gravity, and the severity of your injury.  (eg. A severe ankle sprain may also cause swelling to accumulate into the foot, so bandaging with only the tips of the toes poking out is most effective.)

Elevate - Holding the affected part above the level of the heart will reduce the amount of blood pooling and swelling in the area.  Ideally, if it's ankle sprain, lying in the floor with your leg resting up on a couch is ideal, (sitting on the couch with your ankle at hip height is better than on the floor, but not nearly as effective). Try to rest in positions that use gravity to help drain excess fluid back down towards the heart and lympahtic system.

So, if you sprain your ankle, you'll know:

Lie down on the ground with your ankle resting up on something higher, wear a compression bandage from toes to above the ankle, use ice regularly, and if it's not ok to walk, consider hiring some crutches.

But wait, that's not all . . .

please also do no HARM  - no Heat, Alcohol, Running or Massage

These vasodilate the blood vessels, allowing more blood flow to the area, and therefore more bruising, swelling, pain and further damage.

Despite popular belief in some sports clubs, "rubbing out a corky", having a massage to loosen out a strained muscle, or having a hot bath to loosen it out is unhelpful and potentially doing more damage in the first 48-72 hours.  After that time it may be exactly what you need, but please wait for at least 3 days unless advised otherwise by a qualified health professional.


NSAIDs - Non Steroidal Anti-Inflammatories

Sometimes your Physio may suggest using a short course of anti- inflammatories, either over the counter, or prescribed by your GP.  This is particularly warranted if your pain is a constant ache, disturbing your sleep, particularly bad in the mornings, or affects your nerves.

Anti-inflammatories (eg. Voltaren, Ibuprofen, Mobic etc) are best used for a few days in a row to reduce the amount of inflammation present, and in turn, this reduces pain also.  It is not recommended to take these for longer than 5 days or on a regular basis without medical supervision, due mainly to their side effects on gut health.

It is important you check with a pharmacist or GP if you are taking any other medications, or if you intend to use NSAIDs for longer than a week.