Stop RICEing and Move
By: Paula Burchat, BA, RMT, CSMTA(SF) • September 21, 2017
For many years we have RICE’d when injured -Rest, Ice, Compression and Elevation. This should no longer be the case. Over the last few decades research has demonstrated that immobilizing joints and limbs does not speed healing; that ice doesn’t reduce swelling; and compression leads to an accumulation of swelling not a reduction. A very strong addition to this data is that in 2014, Dr. Gabe Mirkin, the sport medicine doctor who coined the term RICE, stated that research has proven that RICE is not the preferred method for treating acute injury. He stated that rest and ice delay healing and he advocates for using mobilization to reduce swelling.
To get to the heart of what all this means we have to understand that over the last 40 years much of the conversation about ice was based on assumptions. There is an increasing amount of research to support not using ice for acute injuries such as sprains, muscle strains, contusions, as well as for post training recovery. For decades the conversation about ice has also been based on a misunderstanding of the science of inflammation and swelling compounded by a misuse of the terminology even by many people in the sport medicine community.
Inflammation is not the same thing as swelling. Inflammation is your body’s natural and very efficient mechanism for healing and you want to encourage it to work for you. There are many cells in our blood that respond to injury and the first 48 hours is significant for repair and the next 24 hours for more clean up of residue and waste. Swelling on the other hand is the congestion of waste and fluids at the end of the inflammation process and a build up of swelling can cause pain. The basic point here is that you want to encourage inflammation to heal and limit swelling.
Add to this what we now know about ice based on research. Ice stops inflammation while you use it, but then the inflammatory or healing process resumes once the effects of ice wear off. This means ice actually delays the healing process. It is true that ice numbs the area to which it’s applied and this can in some cases reduce pain. However, this short term benefit may lead to a perpetuation of pain in the long term because when muscles are numb they are not sending information to the nerves, which again inhibits the healing process. All this to say then if you use ice you stop the healing process for a while; not something you want to do if you want to heal quickly.
Research also demonstrates that ice does not remove swelling (a cause of pain). Swelling is an accumulation of waste products left behind after cells in the blood circulatory system have done their job in the healing process. This fluid and waste leaks out of the circulatory system and accumulates in the spaces between cells in the injured tissue. Muscle contraction forces the swelling into the one way pump of the lymph system that pushes fluid towards the centre of the body where the waste particles are eventually eliminated through urine, sweat, etc. Ice has been shown to cause a back flow of swelling in the lymphatic system and therefore limits the ability of your body to clear out the waste.
The situation is even worse for those who use anti-inflammatory medication for injuries. Anti-inflammatories do exactly that – stop inflammation – and therefore limit your body’s ability to heal. Remember you want to encourage inflammation. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) have no impact on swelling either and shouldn’t be used when swelling is present. This information comes directly from the warning labels on NSAIDs. Warning labels clearly state that you should stop taking the medication if there is redness or swelling present at the injury site and see your doctor.
In his book, “Iced! The Illusionary Treatment Option,” Gary Reinl, a renowned sports trainer who has worked for over 40 years with every type of professional team, traces the history of the use of ice and the utter lack of research to back it. It’s a good read (if somewhat repetitive) for anyone. He provides anecdotal information backed up by countless research articles outlining the lack of need for ice and in point of fact how it is detrimental to healing.
Reinl started training athletes in the 1970s before the use of ice became the go to for injury and muscle recovery in the 1990s. He advocates using no ice at all and moving the joints and muscles affected by the injury to help move fluids through the injured area. For example, with an ankle sprain you may not be able to walk or move the ankle very much but you probably can move your toes, and flex you knee and hip joints. This pain free contraction of muscle moves the fluid and waste up the one way pump of the lymphatic system.
In my personal experience I’ve witnessed clients heal much quicker with heat and mobilizations after sprains than when ice was employed. These experiences have demonstrated to me that mobility is the key to injury management. This complete paradigm shift will take years to reach all levels of society from doctors to athletes to parents and erase the “common knowledge” of putting ice on any injury. Active recovery is the name of the game now for injury and post training recovery. Gentle, pain free movement that increases in intensity and load as the area heals is the best approach.
What makes this hard for those of us used to RICEing is we no longer have an easy acronym to follow with simple instructions. But once you realize that this “new” approach is what humans have done for all of history except for the last 20-40 odd years it doesn’t seem so bad. For those of us indoctrinated by this medical fallacy we just need to remember that RICE is not nice and to move it or lose it.
Iced! The Illusionary Treatment Option, Gary Reinl
Principles of Anatomy and Physiology, Tortora and Grabowski
J Orthop Sports Phys Ther. 2013;43(7):456. doi: 10.2519/jospt.2013.0504. Epub 2013 Jun 29. “Ankle sprains: combination of manual therapy and supervised exercise leads to better recovery.”