RICE is Out
Stop icing and start moving
Today we break down RICE, how cold therapy impacts (and impairs) recovery, and how to approach recovery.
DISCLAIMER: As always, if you experience an injury ALWAYS speak to a medical professional. This is purely information that may help to better approach and understand methods used by your PCP/physical therapist.
Growing up, RICE was a standard approach to dealing with a sports injury, which stands for: Rest, Ice, Compression, Elevation.
In 1978, Dr. Gabe Mirkin coined the term RICE for the treatment of athletic injuries. But even in the 90s, top athletes were using alternative means of recovery to rapidly recover and perform at the highest level. Donovan Bailey, a Canadian olympian who once held the world record for the 100m sprint, recovered from an achilles rupture rapidly. His surgeon, Dr. Galea is quoted stating “We had him in the water right away, and by ten weeks he was jogging.” A year later, Bailey ran a sub 10 second 100m.
In 2015, Dr. Mirkin retracted RICE, citing a 2013 study in the American Journal of Sports Medicine showing cooling of the muscles delayed swelling but did not hasten recovery from muscle damage.
He also presented a summary from 22 other scientific articles showing no evidence that ice and compression improved healing over the use of compression alone. In addition, he stated the cooling may decrease pain, but it also interferes with the athlete’s strength, speed, endurance, and coordination.
In a 2021 study [link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173427/#sec-5title ] cold therapy on the surface of an injured site is shown to possibly be effective in pain management or swelling, but could lengthen the recovery process.
The reason being: “when we are injured, our body sends signals to our inflammatory cells (macrophages), which release the hormone-insulin-like growth factor (IGF-1).
These factors initiate healing by killing damaged tissue. However, when ice is applied topically, the cold will act as a vasoconstrictor and impede the transport of those inflammatory chemicals and cells to the injured site.
We may prevent the body’s natural release of IGF-1 and, therefore, delay the start of the healing and recovery process. A prolonged period of cold on the skin will lead to a reduction of the blood flow, resulting in tissue death or even permanent nerve damage.”
There is plenty of evidence against using cold to treat injury. But what’s the alternative?
There are a number of present day acronyms, but they all share a similarity: MOVEMENT.
A common method is MOVE, or Movement, not rest, Options: offer other options for cross training, Vary rehab w/ strength, balance, and agility drills, and Ease back to activity early for emotional strength.
Another, called MEAT, includes Movement, Exercise, Analgesics (or pain relieving medication), and Treatment (from therapeutic exercise, ultrasound, manual therapy, and neuromuscular reeducation).
Dr. Jennifer Robinson (of University of British Columbia) stated in a 2017 article (link: https://thischangedmypractice.com/move-an-injury-not-rice/ ) movement directly stimulates tissue healing, as evidenced by our previous reference about the natural release of IGF-1. She also mentions the significance of moderating the emotional cost of injury through permission to move immediately, no matter how small the “movement” is.
There is sufficient evidence to show that movement, exercise, and treatment from a physical therapist leads to faster and more complete healing than rest, elevation, icing, and compression.
A structured exercise developed by therapists create functional stability and strength (also preventing scar tissue composed of collagen fibers), minimizes the deconditioning effects of rest and immobility, as well as muscle atrophy, weakening of connective tissues, and coordination.
The bottom line: as Dr. Mirkin stated, follow your doctor’s advice on rehabilitation if the injury is severe. “With minor With minor injuries, you can usually begin rehabilitation the next day. You can move and use the injured part as long as the movement does not increase the pain and discomfort. Get back to your sport as soon as you can do so without pain”
Returning to sport or your primary training is the most important aspect. Limiting yourself with too much rest can only be detrimental (except for severe injuries). If not for the physical benefits, but the mental benefits from continuing to be active. Movement and rehabilitation starts small, and as i’ve said in the past, do what you can, no matter how small.