RICER. Initial first aid action plan to manage joint injuries such as sprains and strains.

In this Blog, I want to talk about RICER. Joints connect bones. They provide stability to the skeleton, allow movement, and absorb shocks. RICER. Rest Ice Compression Elevate and Refer is our initial first aid action plan to manage joint injuries such as sprains and strains.
Adrian Webb
Content Manager
August 16, 2022
RICER. Rest Ice Compression Elevate and Refer

Table of Contents

Introduction

According to the Urban Dictionary Australia, the meaning of Ricer is:

“Ricer – any person who spends more money to make their car look like it goes fast than they spend on actually making it go fast”

And accordingly, they are subjected to scorn and derision as in – “Dude, that lame ass Honda ricer sucks.!”

As interesting as that is, it’s not what this Blog is about of course.

In this Blog, I want to talk about RICER for First Aid.

In other words, how to recognise the signs and symptoms of, and apply the correct first aid management for, dislocations and  sprains and strains i.e., RICER

RICER is our initial first aid action plan to manage joint injuries such as sprains and strains.

Ricer action plan. Rest, ice, compression, elevate and refer.

Created in 1978 by Dr Gabe Mirkin in his book ” The Sports Medicine Book” the acronym RICE – Rest, Ice, Compression and Elevation, was the standard initial first aid action plan for the management of soft tissue injuries.

In recent years, Referral was added on the end to make it RICER, recognising the need for the first aider to recommend the injured person seek medical advice for their injury. In 2019/20 there were 11,573 hospitalisations for dislocations and soft tissue injuries  (AIHW-INJCAT-225-A-tables) so if you are the first aid officer for your local sporting club on the weekend, it is more than likely you have had to manage soft tissue injuries.

Joints

I reckon the best place to start is with an understanding of the parts of the body likely to suffer dislocation, sprains and strains.

These are the joints.

Joints connect bones. They provide stability to the skeleton, allow movement, and absorb shocks.

Ligaments support parts of the joints while tendons join the muscles to the bone.

Smooth cartilage prevents friction as the bones move against one another.

In freely movable joints, the entire joint is enclosed inside a membrane filled with lubricating synovial fluid, which helps to provide extra cushioning against impact.

In General, the greater the range of movement, the higher the risk of injury. This is because the strength of the joint is reduced.

There are different types of joints allowing different movements.

  • Ball and socket joint –  where the rounded head of one bone sits within the cup of another, for example, the hip joint or shoulder joint. Able to move in all directions
  • Saddle joint – allows movement back and forth and from side to side, but does not allow rotation, such as the joint at the base of the thumb.
  • Hinge joint –where the two bones open and close in one direction only such as the knee and elbow joints.
  • Condyloid joint –movement without rotation, such as in the jaw or finger joints.
  • Gliding joint –where the smooth surfaces slip over one another, allowing some movement, such as the wrist joints.

Common joint injuries include

  • Dislocations – when two connected bones slip out of position in a joint.
  • Fractures and breaks
  • Sprains and strains – of the Ligaments and Tendons around the joint
  • Overuse injuries such as tendonitis –  making the same movements repeatedly over time, the body’s joints and surrounding tendons and muscles become irritated and inflamed.
  • Osteoporosis – bones that are weakened from a loss of bone density, due to a lack of calcium. As a result, the bones that make up the joint may break easily.

Signs and Symptoms of Dislocations

Signs and Symptoms of Dislocations
 include: Pain, Swelling, Bruising, Instability of the joint, Loss of ability to move the joint and Visibly deformed joint where the bone looks out of place.

Management of Dislocations

For a dislocation, DO NOT try to replace or reduce the dislocation! Leave that for the Ambulance or Medical Professional. You might pinch nerves or further injure the arm if the joint is reset incorrectly.

Follow these steps

  1. Follow DRSABCD (Always a good place to start!)
  2. If the injury is to a limb: Check for circulation and, if absent, move the limb gently to try and restore it.
  3. Call 000 for an ambulance.
  4. Place and support the limb using soft padding and bandages.
  5. Use icepacks, if possible, over the joint.
  6. If the shoulder is dislocated, support the arm in a position of least discomfort use a sling if needed and apply an ice compress.
  7. If the wrist is dislocated, support using a sling and apply an ice compress.

When using ice, make sure to apply it for ten minutes with 1 Hour rest in between or 20 minutes on/2hrs off

Sprains and Strains

The difference between a sprain and a strain is that a sprain injures the bands of tissue that connect two bones, while a strain involves an injury to a muscle or to the band of tissue that attaches a muscle to a bone.

Sprain

A common injury seen in ligaments is a sprain.

Ligaments are bands of tough elastic tissue around your joints. They connect bone to bone, give your joints support, and limit their movement. You have ligaments around your knees, ankles, elbows, shoulders, and other joints.

A Sprain is when a ligament supporting a joint is overstretched or torn. Sprains commonly happen in the ankle, knee, or wrist.

Strain

Strains on the other hand occur when a tendon, or muscle, is overstretched or torn.

Tendons are tough, flexible, and inelastic bands of fibrous connective tissue that connect muscles to bones.

Common areas affected by strains are the leg, foot, calf, groin, hamstring and back.

Strains are often the result of repetitive movements and athletics.

Athletes who overtrain their bodies without adequate time for rest and muscle repair in between workout sessions are at increased risk.

For more information, read our risk assessment guide.

Signs and Symptoms for Strains and Sprains

Signs of strains include:

  • Pain
  • Swelling in the affected area
  • Bruising in the affected area

Symptoms of strains include:

  • Sudden pain in the affected area
  • Loss of power in the affected limb
  • The muscle in the affected limb is tender to the touch

Management of Strains and Sprains – RICER

To manage strains and sprains we can follow our primary action plan DRSABCD

and, of course, RICER

  • REST: encourage the casualty to stop any activity and make them comfortable
  • ICE: Apply an icepack, wrapped in cloth, to the injured area
  • COMPRESSION: apply an elastic bandage, if available, over the injured area. Not too tight, you need to allow for circulation
  • ELEVATE: elevate the injured area above their heart height if practical
  • REFER: refer them to a medical professional to have the area looked at

HARM

When treating using RICER you should also do no HARM.

Meaning

  • Heat: NO application of heat to the injury
  • Alcohol: NO alcohol
  • Running: NO activity that might affect the injury
  • Massage: NO massaging the injury.

This method should be used within the first 48–72 hours (depending on severity) after the injury to speed up recovery.

Sprains, strains, and Dislocations are common incidents for First Aiders so remember

  • DRSABCD
  • DO NOT try to relocate a dislocated joint
  • Support the joint and  apply an ice pack
  • RICER for sprains and strains
  • When applying ice pack ensure it is wrapped in material and applied 10 minutes on/1hr off, or 20mins on/2hrs off

And

  • Do no H.A.R.M.

Well, that’s that. Until next time….. Stay safe

Adrian

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Adrian Webb

Adrian joined Life Saving First Aid in 2019 following a 30-year career with the Airport Fire and Rescue Service, where he responded to numerous first aid calls and dangerous or hazardous incidents, keeping the airport community safe.

Since joining Life Saving First Aid, he has delivered First Aid training to over 28,000 students. Many of them have used this training to save a life!

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