Introductions: It is not uncommon to experience injury while doing activities in the wilderness. More than 70% of nonfatal accidents in the wilderness involved musculoskeletal or soft tissue injury. Since 1978, it has been the standard practice to implement RICE (rest, ice, compression and elevation) treatment for most musculoskeletal injuries especially during the early phase of an injury, until recently.
Discussions: Rest aims to reduce inflammatory processes and expedite recovery while preventing further injury of the area. Ice, compression and elevation was believed to help reduce pain, stop bleeding, and reduce tissue oedema.
However, despite its widespread practice and field expert claim of its effectiveness, later research has found that ice and rest not only delays recovery, instead causes further damage to tissues. Studies on compression and elevation also produces ambiguous results and rather inconclusive. There has been more recent evidence which supports other methods of treatment that deviates completely from RICE such as protection, early movement, adequate analgesia and progressive exercise, each with their own benefit and pitfalls.
Conclusion: In wilderness setting, whatever mode of treatment applied should be catered according to the situation that the patient is in, the patient’s condition and injury sustained (stable vs unstable). Stable sprained ankle or ligamentous injury might benefit from early movement and slow exercise but would definitely harm rather than heal in an unstable broken limbs. Similarly, if no other options available and some icing could help the patient walk another mile home, so why not.
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