The P.R.I.C.E. Protocol Principles

Protection, Rest, Ice, Compression and Elevation, or P.R.I.C.E., adds the concept of “protection” to the traditional R.I.C.E. protocol formula. Protecting the injured area from further damage is crucial to the healing process.

Experts recommended acute injury patients use P.R.I.C.E. shortly after the injury occurs. It may be particularly helpful during the first 24 to 72 hours.

P:      Protection is meant to prevent further injury. For example, an injured leg or foot may be protected by limiting or avoiding weight-bearing through the use of crutches, a cane, or hiking poles. Partially immobilizing the injured area by using a sling, splint, or brace may also be a means of protection.

R:      Rest is important to allow for healing. However, many sports medicine specialists use the term “relative rest” meaning rest that allows for healing, but is not so restrictive that recovery is compromised or slowed. A person should avoid activities that stress the injured area to the point of pain or that may slow or prevent healing. Some movement, however, is beneficial. Gentle, pain-free, range-of-motion and basic isometric contractions of the joints and muscles surrounding an injury have been shown to speed recovery.

I:      Ice refers to the use of cold treatments, also known as cryotherapy, to treat acute injuries. Ice is recommended with the intent to minimize and reduce swelling as well as to decrease pain. There are many ways to employ cryotherapy at home. The most common and most convenient is a simple plastic bag of crushed ice placed over a paper towel on the affected area. It is important to protect the skin and limit the cold exposure to 10 to 15 minutes. Cycles of 10 to 15 minutes on and 1 to 2 hours off are generally agreed upon as effective and safer than longer periods of continuous ice application.

Skin sensitivity or allergy to cold exposure can occur. It may manifest as skin that becomes mottled, red and raised where the ice contacted the skin. If this is experienced, the ice treatments should be discontinued. Redness alone, however, is common and should resolve after a few minutes of re-warming.

C:      Compression is the use of a compression wrap, such as an elastic bandage, to apply an external force to the injured tissue. This compression minimizes swelling and provides mild support.

Applying an elastic bandage does require some attention to detail. It should be applied directly to the skin by starting a few inches below the injury and wrapping in a figure eight or spiraling manner to a few inches above the injured area. A medium amount of tension should be applied to provide ample, but not too constrictive compression. The bandage should not cause numbness, tingling, or color change of the soft tissue. Loosening the bandage should quickly alleviate these should they occur. It is generally best to remove or significantly loosen the elastic bandage for sleeping and to re-apply it the next morning.

E:      Elevation is recommended to help reduce the pooling of fluid in the injured extremity or joint. Controlling swelling can help decrease pain and may limit the loss of range of motion, possibly speeding up recovery time.

Elevation is accomplished by positioning the injured area above the level of the heart. Elevation during most of the waking hours, if possible, and positioning the injured limb on extra pillows for sleep is probably most effective in the initial 24 to 48 hours. If there is significant swelling which continues after 24 to 48 hours, or if swelling recurs during recovery, then continued periodic elevation is appropriate.

For many sports and exercise injuries, ice can be secured over the affected area with an elastic bandage and the limb can then be elevated, achieving simultaneous Rest, Ice, Compression and Elevation—the optimum home treatment.