RICE — An Outdated Approach to Healing?

Brianna Clark
October 23, 2018

Since 1978, we have been using RICE (Rest, Ice, Compress and Elevate) treatment to recover from soft tissue injuries (such as strains and sprains). But with new studies emerging on RICE injury treatment methods that question it’s effectiveness, it looks as though the recommended use of this type of treatment will change. And it’s a big deal. Even Dr. Mirkin (who is the father of the RICE treatment protocols) has accepted the need to change RICE treatment protocols with the emergence of this new science. In response to the new studies findings, Dr. Mirkin said: “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.

It’s clear that it’s time to change the way we approach soft tissue injuries. So, let’s look at what can do in place of the old and outdated RICE treatment approach.

Facilitating movement after an injury is crucial for the proper formation of collagen fibers (or, what’s more commonly known as scar tissue). When a muscle is challenged both eccentrically (downward phase of a movement) and concentrically (upwards phase of a movement) after trauma or damage to soft tissues, collagen fibers will start to form in alignment with the muscle fibers. In contrast, limiting or restricting movement will cause the collagen fibers to form a sticky web of misaligned fibers that can cause complications down the road. This in turn will create adhesions in the injured area. And this is true whether it be a muscle, ligament, tendon, or joint capsule that’s been injured. This sticky web of misaligned collagen fibers ultimately results in a limited range of motion and additional pain. Therefore, movement should be re-introduced to an injured area of the body as soon as possible.

The End of an Ice Age?

The body’s healing process for soft tissue injuries is largely dependent on the inflammation process. When muscles and other tissues are damaged, your immune system sends inflammatory cells to the damaged tissue that promote healing. The inflammatory cells called macrophages release a hormone called insulin-like growth factor (IGF-1) into the damaged tissues, which helps injured soft tissues to heal. However, applying ice to reduce swelling actually delays healing by preventing the body from being able to effectively complete this inflammatory process. So while acute (short-term) inflammation (and the associated swelling) may be a little painful and uncomfortable, it’s actually a good thing to have happen. Chronic inflammation can be harmful and should be prevented, but applying ice to an injured area of your body in order to reduce acute inflammation is likely undermining your recovery efforts. Ice constricts blood vessels and restricts oxygenated, nutrient-rich blood that carries inflammatory cells from entering into the injured tissues.

And again: use common sense with this. Sometimes applying ice to an injured area is needed (or even using something more aggressive, like cryotherapy). This is especially true after traumatic injuries or major surgeries. So be sure to consult with your healthcare professional if you’re unsure about when using ice or not is appropriate for you.

picture of ice cold water that someone could get into to treat injury

Does Compression and Elevation Still Have a Place?

Compressing the site of an injury also proves to yield minimal (if not detrimental) results. Similar to the use of ice, compression of an injury can greatly restrict blood flow to the injured area of the body and restrict crucial healing processes.

However, elevating the injured area above the heart doesn’t seem to be significantly detrimental to the natural healing processes of the body, so go ahead and pop that sprained ankle up on a stack of pillows. Elevating an injured and swollen area of the body is actually a great alternative to using ice and compression help reduce painful swelling while still allowing for the inflammation process to work mostly unimpeded. By elevating the injured area above the heart, it allows gravity to help the body to “work out” or “drain” the swelling/inflammation of the injured area. Elevation is a particularly effective RICE treatment alternative in the reduction of swelling reduce when combined with movement. Ankle pumps are a great example of elevation + movement treatment.

So… What Else Can You Do?

The good news: while the RICE treatment method may be outdated and ineffective, there’s still A LOT of things you can do to recover from soft tissue injuries. Here’s some other specific things you can do during injury recovery that I haven’t covered in this article already.

Kinesio Tape

Kinesio Tape (or, K-Tape) is an effective alternative to restrictive athletic tapes or compression therapy that are often used with the RICE treatment method. Unlike most athletic tape, K-Tape lifts superficial tissue rather than compress them, which enables improved lymphatic and blood flow. This can help to keep swelling under control and speed up the natural recovery process.

And as an added bonus: certain K-Taping techniques can also aid in improving proprioception (or spatial awareness) of an injured body segment. This is important because after an injury, the body usually loses some of it’s proprioceptive abilities at the injured site, which can put you at greater risk for re-injury. Think of a sprained ankle. You want to ensure that your body has good awareness and control of the ankle after you’ve sprained it. If not, you’re more likely to sprain it again. K-Tape can help with that!

If you’re in the Salt Lake City area, come see us at our office to learn more about K-Tape and how it can help you recover from an injury.

Move… Better!

As discussed earlier, concentrically and eccentrically loading the muscles of an injured area can help with proper scar tissue formation. Collagen fibers will align with the muscle fibers, which helps you to heal fully without range of motion restrictions. However, that’s not the only thing you should be focused on when moving an injured area of your body. Oftentimes, injuries lead to movement compensations. And sometimes, these injury-rooted movement compensations can last a lifetime if not addressed. And that’s a big problem. Movement compensations put you at greater risk of injury and chronic pain. The worst thing is to get injured. The next worst thing is to let that injury haunt you for years to come due to unchecked compensations.

So, how can you combat injury-related movement compensations? You can fight back by performing a Functional Movement Screening (FMS) test. FMS tests help to systematically identity movement compensations that may be present after an injury. And once identified, they can be fixed. Learn more about how FMS tests can help you recover from an injury here.

Thermal Therapy (When it Makes Sense)

Thermal therapy has its place in RICE treatment alternatives, but only at the right time. Adding heat to an injured tissue that’s already inflamed can be harmful and cause additional pain and discomfort. However, once significant swelling has subsided, thermal therapy can help to promote the natural healing processes of the body. And while there’s a lot of different forms and variants of thermal therapy out there, one of the cheapest and easiest ways to do it is by using a dry sauna. Using a dry sauna is more of a “shotgun” approach than a targeted one, but it’s still an effective way to promote healing in the body.

And guess what? We have a dry sauna here at The Anatomy of Wellness. Give us a call to learn more about our dry sauna packages.

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