RICE for Treating Injuries is Outdated and Ineffective

Written by:
Brianna Clark, LMT

Since 1978, we have been using RICE to recover from an injury thanks to a MD named Gabe Mirkin. RICE (rest, ice, compression and elevation) has been considered the go-to common sense treatment for pain and injury. With new evidence emerging on the topic, it looks as though recommendations for the treatment of soft tissue injury will change. Mirkin has been open about changing treatment protocols with the new science.

Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.” – Gabe Mirkin, MD, March 2014

 

Ice is Out and Movement is In

Facilitating movement after an injury is actually crucial for the formation of scar tissue. When a muscle is challenged both eccentrically and concentrically after trauma or damage to soft tissue, collagen fibers will start to form in alignment with the muscle fibers. Limiting or all together restricting it will cause the scar tissue to form a sticky web of collagen. This in turn will create adhesions in the area whether it be muscle, ligament, tendon, or joint capsule. The result is limited range of motion and pain.

 

The End of an Ice Age

The healing process is fully dependent on the process of inflammation taking the lead. When muscles and other tissues are damaged, your immune system sends inflammatory cells to the damaged tissue to promote healing. The response to both infection and tissue damage is the same. Inflammatory cells rush to injured tissue to start the healing process (Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999).

The inflammatory cells called macrophages release a hormone called insulin-like growth factor (IGF-1) into the damaged tissues, which helps muscles and other injured parts to heal. However, applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1. (stoneathleticmedicine.com)

 

To ice an new injury would inhibit the inflammatory process thus delaying recovery and healing. Ice constricts blood vessels so oxygenated, nutrient rich blood carrying inflammatory cells will not be allowed into the injured area to do their work.

It is also a notable fact that other inflammation inhibitive treatments will have the same limiting effect such as NSAIDS and cortisone drugs. 

Compression Isn’t Any Better

To compress an injury site also proves to yield minimal if not all together useless results. Again, blood flow is crucial to healing. And movement is required even in the acute stages to form healthy scar tissue. Elevating the injured area above the heart doesn’t seem to hurt the situation so go ahead and pop that ankle up on a stack of pillows.

So what should you do instead?

There are a few things you can do to help yourself after an injury. 

Kinesio Tape

Kinesio tape is an effective alternative to restrictive athletic tapes. Kinesio tape lifts superficial tissue allowing for adequate lymphatic drainage to keep swelling under control. It’s unique design aids in movement and proprioception while reducing pain. 

Movement

Concentrically and eccentrically loading the muscles injured with ver light resistance such as when you move in a swimming pool will lead the body to lay down functional scar tissue. Collagen fibers will align with the muscle fibers helping you to heal fully without range of motion restrictions.

Thermal Therapy

It is best not to add heat to a newly injured area either. The tissue will already be hot and inflamed, no need to perpetuate it. Once inflammation has subsided and you are in the subacute phase of healing, then ice can be used as an analgesic. There are also topical analgesics on the market that work really well. We carry Cryoderm products in our office because we love their potency and efficacy.

Research is pointing to a whole new way of soft tissue injury rehab. What will the new acronym be?

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