RICE or ice: what does the evidence say? The evidence base for first aid treatment of sprains and strains

Borra V1, De Buck E1, Vandekerckhove P1
1Belgian Red Cross-Flanders, Mechelen, Belgium

Background: Belgian Red Cross-Flanders develops evidence-based first aid guidelines for laypeople, as a part of its strategy to give evidence-based support for all its activities. In the revision of the Flemish first aid manual, the effectiveness of RICE, an acronym for Rest, Ice, Compression and Elevation, as a treatment for sprains and strains, was investigated. Current recommendations state that a person should not move the injured limb and to apply ice to the injured area. Furthermore, it is suggested that a compression bandage might give relief.

Objectives: To look for evidence to support RICE in the treatment of sprains and strains as a part of the Flemish First Aid Guidelines.

Methods: Four separate searches were performed in four databases (MEDLINE, Embase, CENTRAL and CINAHL) to search for systematic reviews and intervention studies on the use of rest, ice, compression and elevation in the first aid treatment of strains or sprains. We included interventions that are performed by lay people, or that it would be feasible for lay people to perform.

Results: Thirteen studies were included. Of these studies, five showed limited evidence in favour of mobilisation, four in favour of the use of ice and another four showed limited evidence refuting the use of compression. No evidence was found for the use of elevation. Evidence was of low to very low quality and results were imprecise due to limited sample size, lack of data and/or large variability of results.

Conclusions: The evidence confirms the application of ice. Furthermore, the recommendation not to move the injured limb might stay in, since the evidence we found against rest concerned the recovery phase and not the acute (first aid) phase. The recommendation about use of a compression bandage, however, might change since the evidence does not favour compression in the treatment of strains or sprains. A multidisciplinary panel of experts will discuss new draft recommendations while taking into account this evidence.

This evidence also shows that updating first aid guidelines is relevant, since recommendations might change based on new evidence and updated methodology.