To RICE, or Not to RICE...

Has the mainstay method for treating acute soft tissue injury actually been detrimental to our recovery?

RICE

The traditional RICE (Rest, Ice, Compression, Elevation) method for acute injuries has been used since its inception in 1978 for the treatment of acute injuries. First coined by Dr. Gabe Mirkin in his Sportsmedicine Book, this method has been the standard treatment for sports injuries and sore muscles. For many of us, whether we played sports or not, if we suffered any kind of soft tissue injury we were undoubtedly told to immediately ice the injured area. When I played Lacrosse in high school I suffered from a severe ankle sprain during warm-up and was told to keep my cleat on for compression and to ice the area that I could for the remainder of the game. In the days to follow, I used the RICE method to help recover from the injury, but was it truly helping me recover? Or was it just helping decrease the pain, and prolonging my recovery?

Impact of RICE on tissue healing

Inflammation is a natural response of the body to injury or infection, and for acute circumstances should not be avoided. Our bodies are designed to help keep us alive, and the natural responses we have all have one goal in mind, to keep us safe and alive. So how does RICE affect our bodies one goal? Let's break it down.

Rest

Rest after an injury can have a positive impact if done properly. Most of our body's healing processes kick into gear during sleep so it is definitely important to get adequate amounts of sleep at night, especially after an injury. But outside of our daily sleep routine, too much rest can actually have a negative impact on our body's ability to heal from an injury. Although it may be difficult within the first few days after an injury, it is important to get back to pain-free movement and load as soon as possible to help increase recovery and decrease stiffness and loss of muscle mass. The key to this, however, is pain-free. Trying to get back to full activity too soon can result in repetitive injury and may result in a chronic injury, so take it slow and easy during recovery. Find the sweet spot for you with regard to rehab and rest, as not every injury should be treated the same.

Ice

This is where most of the debate is stemming from with regard to the RICE method. As I said before, the natural response of the body when facing an injury is to increase inflammation to the area to allow our immune system to begin the healing process. That's right, our immune system also is what helps you to heal from injuries, not just infections. Your immune system is activated after an injury and is vital to starting the phases of healing. The main reasons we use ice for injury treatment is to decrease inflammation, the body's natural response to injury and infection, and to numb the pain. So by using ice for injury treatment, we are halting our natural ability to heal mostly just for that analgesic effect as the only benefit. This isn't me saying that ice should never be used, as that is not the case. If the injury is substantial and inflammation to an area could cause death or loss of limb, then, of course, it is HIGHLY recommended. But for the average injury, ice is less beneficial and can actually lead to increased recovery time and decreased ability to start moving the injured tissue. Due to the dual nature of this treatment, it is always recommended to consult your Doctor when determining whether your should, or shouldn't ice.

Compression

Compression post-injury is still, by all means, viable, so long as it is not impeding your ability to move the injury. Wearing compression socks/sleeves and the like still has benefits and has not been shown to negatively impact the healing process as it proves stability, decreases swelling (but not inflammation), and helps to limit intra-articular edema.

Elevation

Although there is not much supporting its use, elevation can still have an impact on swelling and fluid retention. So while you are resting, not too much I hope, feel free to elevate the injury above your heart, to your heart's content!

Conclusion

The overall take of the healthcare community, and even the founder of the RICE method himself, is moving away from this protocol when treating acute soft tissue injuries with the two biggest negatives in it being the Rest and Ice. As always with healthcare and its love of acronyms, there is always going to be new research and new technologies for treatments of various conditions. And of the acronyms that have surfaced so far to replace RICE, PEACE and LOVE has been the one I have liked the most. It encompasses much of what was discussed in this post, but most of all encourages you to let your body do its thing without unnecessary intervention. Often times we forget just how intelligent our bodies are, so the next time you or someone you know suffers an acute injury, that is not necessitating emergency services, forget the old ways of RICE and try looking into PEACE and LOVE instead.

Sources

1. https://www.drmirkin.com/fitness/why-ice-delays-recovery.html

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173427/

3. https://www.grandslamphysio.com.au/the-ice-debate-is-icing-your-injury-still-the-right-thing-to-do/#:~:text=The%20research%20shows%20icing%20disrupts,process%2C%20muscle%20repair%20and%20regeneration.

4. https://bjsm.bmj.com/content/bjsports/54/2/72.full.pdf