R.I.C.E Outdated and Potentially Harmful??

R.I.C.E – Rest. Ice. Compression. Elevation… We’ve all been there and we’ve all had injuries that we adhered to this religiously for (or at least thought we should have done more of this to help with the healing…). Believe it or not though, this is largely based on myth and there is very little evidence to show that particularly the ice and rest components are of any benefit at all. In fact there is emerging research that shows that in some cases these things might actually be delaying or hindering the healing process! So much so that Dr Gabe Mirkin responsible for the acronym in the first place recently recently wrote a post updating his position on the recommendation to use “rest, ice, compression and elevation” for the immediate treatment of sports injuries, such as strains and sprains. Citing current evidence, Dr. Mirkin writes that it now “appears that both ice and complete rest may delay healing, instead of helping.”

Its many years since I have recommended ice to patients, and yet it is taking a long time for this message to get out there for some reason – I still have patients come in frequently and say “I know I should have been icing it…”. Really ice will cause constriction of the localised blood vessels and impede the inflammatory reaction. Previously it was thought that this inflammatory reaction was problematic, but it is in fact a critical part of the healing process – imagine that the body has a useful process to kick start healing!

And let’s talk about rest too – complete rest is very rarely needed for an injury, instead appropriate amounts of well directed and targeted movement will actually aid the healing process and produce a stronger and more flexible healed tissue. Add to that a faster recovery time and its a sure win!

Waht about the last two components compression and elevation – well the jury is still out here. Both of these things can help with pain, and theoretically by helping to prevent a buildup of fluid in the area and encourage fluid movement out of the area should also be helping to reduce build up of localised waste products and pain causing substances. Something that gentle movement of the area is also crucial for 😉

References:
Topical cooling (icing) delays recovery from eccentric exercise-induced muscle damage. Tseng, Lee, Tsai et al.

Effect of local cold-pack application on systemic anabolic and inflammatory response to sprint-interval training: a prospective comparative trial. Nemet, Meckel et al. Eur J Appl Physiol. 2009 Nov; 107(4): 411–417. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762537/

Does Cryotherapy Improve Outcomes with SOft Tissue Injury? Hubbard & Denegar. J Athl Train. 2004 Jul-Sep; 39(3): 278–279 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC522152/

J Strength Cond Res. 2013 May;27(5):1354-61. https://www.ncbi.nlm.nih.gov/pubmed/22820210