Sprains and bruises: the PECH rule
For sprains, strains and bruises, the PECH rule (in English often RICE) helps: Pause (rest), Eis (ice – cool, never directly on the skin), Compression (gentle pressure with an elastic bandage) and Hochlagern (elevate). Severe pain, deformity, numbness or being unable to bear weight can point to a fracture – then get medical help, with serious injuries call the emergency number (112 in the EU). This text does not replace a first-aid course.
- Immediately; cooling with breaks over some time
Explained simply
When playing, running or hiking, it is easy to roll an ankle or bump yourself. Then the spot hurts, swells and sometimes turns blue. For such injuries there is a memory aid: PECH (in English often RICE).
P stands for Pause – stop at once. E stands for Eis (ice) – cool it, but never directly on the skin, always with a cloth in between. C stands for Compression – gentle pressure with an elastic bandage, but not too tight. H stands for Hochlagern – raise the arm or leg.
If you cannot put any weight on it, the joint looks crooked or fingers or toes go numb, something may be broken. Then a doctor needs to look at it, and with serious injuries you call the emergency number (112 in the EU). This text does not replace a first-aid course.
How it works
In a sprain, the ligaments that hold a joint together are overstretched or partly torn. In a bruise, muscles and small blood vessels are crushed. In both cases blood and fluid seep into the tissue – it swells, hurts and changes colour.
Resting prevents the injury from getting worse. Cold relieves the pain. Gentle pressure and elevation are meant to help less fluid collect in the tissue. The body has to heal itself – that takes days to weeks.
What really matters
First check whether it could be more than a sprain: deformity, an open wound, very severe pain, numbness or cold, pale fingers or toes. Then leave the limb as it lies, straighten nothing and call the emergency number.
When cooling, always use a cloth between the cold and the skin and take breaks. Only wrap a bandage tightly enough that fingers and toes stay warm, pink and with normal feeling – and check this regularly.
Safety and limits
Whether a ligament is torn or a bone is broken often cannot be seen from outside. If the joint cannot bear weight, the swelling is severe or the pain does not clearly improve after a few days, the injury needs a doctor.
This text does not explain splinting or painkillers. With injuries to the head, neck, back, chest or abdomen after falls or accidents: do not move the person and call the emergency number.
On the trail and in everyday life
Far from help, one question matters most: can you bear weight safely? If not, limping on is risky – better to call for help, stay warm and be found. Cold stream water on a cloth replaces a cold pack.
Good footwear, warming up before sport and attention on uneven ground help prevent injuries. An elastic bandage and an instant cold pack fit in any first-aid kit; a course shows you how to apply the bandage properly.
Step by step
- 1
P – Pause (rest)
Stop the activity at once: sit or lie down and do not keep moving the injured joint. In sport, do not "play on".
- 2
Rule out a serious injury
Look for deformity, open wounds, very severe pain, numbness or cold, pale fingers or toes. If any of these are present, leave the limb as it is and call the emergency number.
- 3
E – Eis (ice / cool)
Apply a cold pack, ice in a bag or a cloth soaked in cold water – always with a cloth between the cold and the skin. Take breaks in between so the skin can warm up again.
- 4
C – Compression
If you have learned how, apply an elastic bandage with gentle, even pressure. Then regularly check the colour, warmth and sensation of the fingers or toes.
- 5
H – Hochlagern (elevate)
Raise the injured arm or leg comfortably, ideally above heart level, for example on a backpack or cushion.
- 6
Get it checked
See a doctor if the joint cannot bear weight, the swelling is severe, the pain does not clearly ease after a few days or there is doubt whether something is broken.
Common mistakes
- Putting ice directly on the skin
- Cooling for hours without breaks
- Wrapping the bandage so tightly that fingers or toes turn cold
- "Carrying on" or walking on in pain although help is within reach
- Straightening a deformity yourself
Quick view
Materials
Ice packs
Always wrapped in a cloth
Do not fill water bottles to the brim for freezing – water expands as it freezes.
Cotton cloth / T-shirt
As a layer between the cold and the skin
Removes coarse particles only – no disinfection.
Sterile dressings and bandages
Elastic bandage for gentle pressure
Open sterile packaging only immediately before use; observe the expiry date.
First-aid kit (household)
Does not replace a first-aid course; check contents and expiry dates regularly.
Suitable for
- Rolled ankle, twisted knee, knocked arms and legs
- Sport, hiking, everyday life
Not suitable for
- Open wounds, visible deformity or protruding bone
- Injuries to the head, neck, back, chest or abdomen after falls or accidents – then call the emergency number
Prerequisites
- No sign of a serious fracture or spinal injury
- Cooling material and a cloth
Safety
- This text does not replace a first-aid course. First aid is learned through hands-on practice under instruction. In an emergency always call professional help – via the local emergency number (112 in the EU) – and follow the dispatcher's instructions.
- Never put ice or cold packs directly on the skin – always use a cloth in between and take breaks, otherwise cold injury can occur.
- An elastic bandage must not cut off circulation. If fingers or toes become cold, pale, bluish, tingle or go numb, loosen the bandage at once.
How it works
In a sprain, ligaments are stretched or torn; in a bruise, tissue and small vessels are crushed. Blood leaks into the tissue, the area swells and hurts. Resting prevents further damage. Cooling relieves pain and can limit swelling. Gentle pressure and raising the limb above heart level are meant to stop a lot of fluid collecting in the tissue. Whether a ligament is torn or a bone broken can only be clarified by a medical examination.
Advantages
- Simple memory aid
- Can be done with everyday items
- Relieves pain quickly
Disadvantages
- Does not replace a diagnosis – fractures are easily missed
- Compression needs some practice
Deep knowledge
Background
The PECH rule is taught on German-language first-aid courses for blunt injuries to joints and muscles; in English there are similar mnemonics such as RICE. The ERC first-aid guidelines consider applying cold to closed soft-tissue and joint injuries useful for relieving pain and warn against ice in direct contact with the skin.
Ankle sprains are among the most common sports injuries. Good footwear, warming up and paying attention on uneven ground reduce the risk.
Variants
- On the trail
- Far from help, first establish whether you can bear weight safely. If not: do not limp on but call for help and stay warm. Cold stream water on a cloth can replace a cold pack.
Common mistakes
- Putting ice directly on the skin
- Cooling for hours without breaks
- Wrapping the bandage so tightly that fingers or toes turn cold
- "Carrying on" or walking on in pain although help is within reach
- Straightening a deformity yourself
Limits and risks
- Does not replace a first-aid course or a medical examination
- No painkiller recommendations
- No improvised splinting – if a fracture is suspected, keep still and get help
Material alternatives
Derived from material properties: a substitute must have all relevant properties. Observe the notes on the substitute.
- Sterile dressings and bandages
- Cotton cloth / T-shirt (Removes coarse particles only – no disinfection.), Mosquito net (Flammable – keep away from flames.), Fine cloth or muslin net against flies (Keep clean and dry; do not hang it over the flames.)
Results come exclusively from structured entries. No improvised instructions are generated.
Sources
European Resuscitation Council – Resuscitation (journal) (2021): European Resuscitation Council Guidelines 2021: First Aid
Applying cold to closed soft-tissue and joint injuries, no direct ice contact
Deutsches Rotes Kreuz (DRK): Erste Hilfe – Informationen und Kurse
PECH rule for sprains and bruises
International Federation of Red Cross and Red Crescent Societies (IFRC) – Global First Aid Reference Centre (2020): International First Aid, Resuscitation, and Education Guidelines 2020
First aid for muscle, ligament and joint injuries