Many of us will be aware of the R.I.C.E.R principles for soft tissue recovery after acute injury. Recently this acronym has been rearranged to better reflect the relative importance of each point, giving rise to the new and improved ‘C.R.I.E.R’ acronym.

Compression     The use of bandaging (or tubigrip) to compress the injury site is the most powerful way to limit swelling

Rest                         Relative rest from any activity involving the injured site ia important for the first 48 hours. Resumption of gentle movement after this point will then aid in the recovery process.

Ice                            Applying ice or cooling agent for 20 minute periods as often as is practicable will cool the injured site, further limiting swelling

Elevation              Keeping the injured body part at or above the level of your heart also helps to prevent swelling

Refer                       If symptoms persist after 24-48 hours, you should refer to a professional. Your Physiotherapist/GP will be able to provide you the guidance to ensure that the injury is managed optimally, getting you back to your goals as soon as possible

The clear aim of the C.R.I.E. protocol is to limit the pain and swelling that follows an acute injury. The application of ice or other cooling modalities in particular was thought to prevent the inflammatory process from taking place. Swelling is a response to the body’s natural local inflammation that follows an acute injury. This inflammation not only increases the body’s sensation of pain, but swelling in the joints can also significantly affect range of movement (ROM) and proprioception – both of which can negatively affect our balance and increase our risk of falls and subsequent injury. This is why anti-inflammatory treatments are so popular after acute soft-tissue injury.

However, it’s important to realize that inflammation is not all bad…

Previously, the general consensus seemed to be that inflammation was bad and that we must do what we can to stop it. These days, more and more evidence is showing that the body’s natural inflammatory response may play a key role in the regulation and release of growth factors and hormones required for soft tissue healing. Such evidence suggests that although application of Ice to an acute injury may reduce inflammation and pain in the short term, it may actually delay long term recovery. Although this is only relatively new research, these results are promising to change the way we manage our acute soft tissue injuries.

There is little doubt whether ice reduces pain in the acute setting. What is still debated upon however is the alleged anti-inflammatory effects of Ice, stemming from mounting questions whether icing only delays the inevitable. Some critics are convinced that inflammation will occur once the area of the body heats up again. Adding fuel to the fire is the emergence of evidence that suggests the practice of icing muscle tissue post-injury can actually cause muscle cell death.

Although these reports do raise some suspicion, more conclusive evidence is needed to warrant a complete paradigm shift. For the meanwhile, the analgesic effects and the short-term benefits of ice and other cooling treatments such as cold water immersion (CWI) justify this treatment within certain contexts. For example, for elite athletes during competition, the short-term analgesia and anti-inflammatory effects are a priority. Thus, it is not uncommon to see or hear about footy teams doing CWI and ice baths or outdoor cold-water ocean training to aid in their muscle recovery.

As for the average person, if a musculoskeletal injury is giving you any concern the CRIER principles seem to have stood the test of time and can be adhered to without great risk of negative side-effects in an acute setting… Especially when compared to certain pharmacological alternatives.

Just remember, as the second ‘R’ in the acronym suggests; if there are any concerns or if the pain continues even after compression, rest and icing – It is then important to see your physiotherapist as soon as possible. They will be able to accurately assess which structures have been damaged and guide you through the appropriate rehabilitation to ensure a safe and timely return to activity.

Vatche Douzmanian

Physiotherapist

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