Supportive care for hemophilia: Using R.I.I.C.E.

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Learn how the acronym R.I.I.C.E - Rest, Ice, Compression, and Elevation - help teens with hemophilia manage their bleeds a lot more easily.

As you have learned, it is important to recognize bleeds and get urgent medical care. After a bleed occurs, it takes time for the damage to heal. You need to slow down. There are simple ways you can start this healing process by following an easy to remember acronym called R.I.2C.E: Rest, Ice, Immobilization, Compression, and Elevation.

If you think of your joint space as a balloon and the blood as water in the balloon, you can appreciate the importance of not over-stretching the balloon to make sure damage is minimized. Each step of R.I.2C.E. can be thought of as handling a delicate, very full water balloon.


Just as you want to limit how much you play with a water balloon so it won’t break, you should also rest your bleeding joint right away. As your factor kicks in, the bleeding will slow down. Rest helps your tissues heal and lowers the risk of that joint bleeding again. Depending on the injured joint, this may mean no walking, running or throwing. Talk to your physiotherapist regarding how long you should rest your joint.


Most materials shrink when they are cooled. If you filled up a water balloon with air, took it from a warm space to a much cooler space, the temperature would drop. The overall volume of the balloon would drop as well. A similar thing happens when you apply ice to your joints. If there is less space in your joint, less blood can accumulate inside and cause damage.


You can prevent the balloon from bursting by placing it in a bucket with several other balloons. This will give added support since the balloon cannot freely move. Similarly, you can immobilize an injured joint. This is why you use a splint or make sure you keep it completely still. Your physiotherapist can help guide you on how long you should keep your joint still. This way, you are not causing more damage to the synovium, cartilage and bones.


Squeezing a partially-filled water balloon makes it difficult to fill it up with water. Similarly, putting a tensor bandage around your joint compresses it from all directions, slowing down the bleed. Using a stretchy tubular bandage (tubigrip) around your joint also helps. Watch closely for any numbness, tingling or pins and needles and discontinue compression if these occur. These may be symptoms suggesting that pressure is building up from the bleeding, also called compartment syndrome. These symptoms need urgent medical attention.


To pour water easily into the balloon, it needs to be positioned slightly below the garden hose. This way the water doesn’t also have to overcome the force of gravity! The opposite is true for your injured joint. It is harder for your heart to pump blood into the joint if you elevate your joint above your heart. If you have a bleed in your knee or ankle, you can lie comfortably on the couch with your leg up. This makes sense intuitively too. If you lower your leg you can actually feel blood rush to that spot you are bleeding into.

Remember, bleeds damage and even destroy some of the internal tissues your joints need to work properly. Even after a few bleeds this damage can become irreversible. This makes it even more important to remember the acronym R.I.2C.E so you can avoid long-term damage to your joints.

Last updated: March 13th 2019