MOVE an injury not RICE (2017)
thischangedmypractice.com
thischangedmypractice.com
To address this specific point (not the rest of your comment, which I largely agree with): this is in line with the "old" bio-medical model of pain, and not up to date with the modern bio-psycho-social model of pain. In many cases, the biological insult to tissues will fully heal far in advance of pain subsidence, or conversely will heal long after pain subsidence. The point being that a pain experience is not an accurate indicator of the state of one's tissues.
For a primer on this more modern model of pain experiences, please give this excellent video a watch: https://www.youtube.com/watch?v=lCF1_Fs00nM
Let's start with injury - what constitutes an injury? As in, how should the word "injury" be defined? This is a more complex issue than one might initially assume; not all pain is associated with an insult to tissue, not all insults lead to mechanical damage, insults that do lead to damage do not necessarily lead to pain, etc. So, mostly, injury tends to be defined as anything that leads to a reduction in function/performance in an organism. The ramifications of this definition are important, because things like a compound fracture, delayed-onset muscle soreness, and pain with no (known) underlying cause all meet the definition's criteria.
That last bit is the most important (and why I strongly recommend watching the video), because pain is not an input to the brain, rather it is an output of some function in the brain that takes a large number of inputs other than pain. This is basically the crux of the whole bio-psycho-social model, and why I said the original question is sort of the wrong question regarding injury. So here's the revelatory part, as it relates to the original question: aside from large and obvious traumas like a compound fracture, one cannot conclude that, because they are experiencing pain, physical damage to tissue has taken place. So looking for a heuristic to determine the state of some tissue after experiencing an event that led to pain is not really the right approach from the beginning, as one cannot be confident (and should not assume) that the tissue's state is awry at all.
The existence of pain itself is predicated on its accurate coupling to injury, since the purpose of pain is inhibitory: this hurts, so stop doing it, [because tissue is injured], and it must not continue to be injured.
There are of course some counterexamples where this line of thinking fails: pain localized to previously amputated limbs comes to mind.
But overall I can think of very few instances where this is true. The magnitude of pain may or may not be proportional; the location may or may not be correct (as in referred pain); but in the vast majority of cases that can I bring to mind, pain very much does indicate tissue damage.
(And the biopsychosocial model of pain doesn't change that! The brain, after all, is tissue.)
> pain very much does indicate tissue damage
These statements are not supported by modern research. The bio-psycho-social model indicates that pain is a threat detection and deterrent mechanism, NOT a "status report" from the painful tissue to the brain. In other words, the brain is concerned that something might lead to physical trauma, yet none need to have taken place for pain to be generated.
There are certainly biological inputs to the "pain generator" function of the brain (like sensing a foreign object touching one's skin), but psychological factors/contexts and social factors/contexts can be equally strong inputs (and ultimately generate a significant pain experience without any, or with very little, biological input).
Think of the magnitude of pain response to a given situation as an indicator sitting somewhere on a spectrum between "benign" and "dangerous". The more psychologically threatened one feels, the more the pain response will be shifted toward the "dangerous" end (i.e. higher magnitude). The more socially threatened one feels, the more the pain response will be shifted toward the "dangerous" end.
Here is a somewhat contrived but favorite example of mine. One night, you wake up to go to the bathroom. In the dark, you unexpectedly step on your child's lego brick left on the floor, and it hurts immensely - it feels like the pegs are actually spikes! This is mainly because of how it has surprised you; the context is that it's dark, you expected the trip to the bathroom to be just a few simple steps, and (for sake of argument) have never stepped on a lego before. Your brain feels rather threatened by this surprising situation and generates a large pain response. Now, a night or two later, it happens again, and though it hurts it definitely isn't as bad. Another night or two later, it happens a third time, and barely hurts at all (you're basically to the point of expecting it now). I think we can agree that no tissue damage has really been done, and if pain was simply a state-of-tissue indicator then the magnitude of pain should have been the same each and every night. Additionally, if tissue damage need be present for pain to be present, why did it hurt at all?
Lastly, I'll note that lack of apparent examples != lack of evidence.
A quick search returns several data like https://www.ncbi.nlm.nih.gov/m/pubmed/11832356/
The era of no pain no gain workouts should be done by this point but no like that...
(I ask this because my own dog has the fastest moving tail I have ever seen, and I hope that is not a danger to her).
This is true only in the short term IMHO. Most people discount (or are unaware of) the severity of long term use leading to gastrointestinal issues. NSAID enteropathy is no joke...
RICE is for serious things that render you incapacitated.
If you can remain active with the injury then you do so, and monitor it: if it gets better with activity, then keep with it. If it worsens, back off. Very simple.
> The resulting vasoconstriction from cooling, not only reduces tissue oxygenation with necrosis if extreme, but inhibits the inflammatory response needed to initiate healing.
Wondering if this means applying heat would speed up healing due to increased blood flow.
Manage it, don't let it go wild, and don't try to drug/compress/ice it into oblivion and make it last longer.
Currently have my moderately sprained ankle elevated. This is the worst sprain I've had in 20 years, so taking it really easy.
Two weeks after that I watch something about sports injuries and realise how much better things would have been had I just bought some ice after my bicycle crash and got myself a cab home instead of riding the ten miles or so, up and down over a big hill.
This was with the NHS and if I was running that department I would have a big bag of ice, right there on reception with a 'help yourself' sign. People wouldn't have to wait for four hours before being seen to, not that RICE was even on offer.
RICE would have been nice, maybe with an upgrade to this MOVE thing.
That said, for suspected broken bones an X-ray really is recommended. Depending on the nature of the fracture, you might need a cast instead of a sling and even the most experienced doctor can't tell you which until they've seen the X-ray results.