R.I.C.E. Treatment is Outdated
by Alison McGinnis, PT, DPT, FAFS
Have you ever used rest, ice, compression, and elevation (RICE) to treat an injury before? If you answered yes, you’re not alone. R.I.C.E. was coined by Dr. Gabe Mirkin in 1978 as a treatment for athletic injuries as ice provides great pain relief. And it has been a standard treatment for athletic injuries and sore muscles ever since. But it turns out this may not have been the best advice after all, as both ice and complete rest have been proven to delay healing, instead of helping. Even Dr. Mirkin has changed his recommendations.
Healing requires inflammation. When tissue breakdown occurs from either a hard workout or injury, inflammatory cells are sent to the region to start the healing process. These cells release Insulin-like Growth Factor (IGF-1) in the damaged tissues to stimulate them to heal. When ice is applied, it prevents IGF-1 from being released which delays the healing process. Ice also causes vasoconstriction of the blood vessels in the region, causing a slowing of blood flow which further decreases the amount of healing cells that can reach the area. And these blood vessels do not open fully again for several hours after the ice is removed. Other than also delaying healing, this can cause the tissues to die or cause nerve damage in extreme cases.
Ice will also decrease your speed, coordination, strength, and endurance (Sports Med, Nov 28, 2011). Ice has been used as a short-term treatment to get an injured athlete back into a game, but will cause a significant decrease in performance and increases the risk of greater injury if a re-warming period isn’t used. The authors recommend that if cooling is done to limit swelling, it should last less than 5 minutes, and must be followed by a progressive warming period prior to returning to play.
So what should you do instead?
Compression and limited elevation are still good recommendations for excessive swelling in an area from an acute injury. I recommend using a VooDoo wrap for short, intense compression or an ace bandage or compression garment for more prolonged wear. Rest has been changed to movement, focusing on small low load movements to the region to encourage new tissue growth in an organized fashion and enhance flushing of lymph and blood to remove debris and bring in new, nutrient-rich blood. Movement should be gentle and within your pain tolerance, but performed as often as possible.
If you must use ice for its pain relieving properties, use it as a hot-cold pump instead of a prolonged treatment. Place the ice on the area for less than 5 minutes (cold), then take it off and move the body part around gently for 5 minutes (hot). Then you can repeat cold to hot treatment as many times as you want. This way you still get pain reduction from the cold sensation, but you get increased blood flow by moving the body part to improve circulation.