Written by: Ali Miletic
How and when to use the Rest, Ice, Compression, and Elevation protocol.
Q: I’ve heard recently that the RICE protocol for humans is outdated. Does this apply to horses as well?
There has been some recent discussion in human medicine that the common way of treating an acute injury (especially soft tissue, like a sprained ankle) through Rest, Ice, Compression, and Elevation (RICE) is outdated and can actually do more harm than good. Let’s look at the components:
Resting an injury is never a bad idea. It allows the body to heal, and is usually the best way to prevent excessive pain and further damage.
Icing is used to reduce inflammation, pain, and bleeding. Vasoconstriction occurs when cold is applied to an area; when the vessels constrict, less blood flows through them and therefore less blood is brought to the area, resulting in less swelling. Cryotherapy, or use of cold temperatures as medical therapy, is also considered an analgesic (pain reducer). This is accomplished by changing the threshold for the conduction of nerve impulses to and from the tissue.
Gentle compression of the injury provides support, reduces movement, hemorrhage, and edema of the affected area. There is also research that shows this compression aligns scar tissue more appropriately around the injured area. This reduces the chance of decreased range of motion when the injury is healed.
Elevation of the injury also decreases blood flow to the area, therefore decreasing edema. This is obviously next-to-impossible when dealing with an equine injury; however, understanding the concept of why these actions are recommended is important.
What is the controversy over RICE treatment?
The controversy over the RICE treatment protocol in humans focuses mainly on the use of cryotherapy. The most recent research regarding RICE suggests that icing really has no lasting affect when it comes to reducing heat and inflammation. It only works temporarily – once the cooling agent is removed, the inflammation returns. When any type of cooling agent such as ice is applied to a muscle injury, there may be a permanent change in the way the nerves signal the muscle fibres. This can lead to risk of re-injury after the acute injury has healed. There are also human studies that have shown that icing a muscle injury can kill muscle cells.
In horses, while the analgesic effect the ice provides reduces pain in the injured body part and allows the horse to be more comfortable, it is important to remember that pain is there for a reason – to remind the horse to not use the injured part of its body.
Is the RICE protocol worth the effort?
In conclusion, ongoing research suggests that in humans, the icing part of the RICE treatment protocol may not be worth the time and effort. However, cold therapy currently remains the gold standard for treating soft tissue injuries (tendons and ligaments) in horses, and should be combined with controlled exercise (hand walking) and possibly other regenerative treatments such as platelet-rich plasma or stem cell therapy, ultrasound, etc.
With very little cryotherapy information available on animal models, discussing the appropriate course of treatment for your horse with your vet is always the best course of action.