Forget R.I.C.E
Most people have heard that they should use ice on their injuries. Many are familiar with the term “RICE”, standing for Rest, Ice, Compression, and Elevation. This model was coined in 1978 by Dr. Gabe Mirkin, and was printed across the sports medicine literature. Thought to be the standard of care for acute injuries, in 2015 Dr. Mirkin came out and recanted his statement, reporting that the research shows icing an injury actually delays healing.
Inflammation isn't all bad
Inflammation is the first stage in the process for healing. Many mistake the word inflammation for swelling, however this is not the case. Inflammation is the first step in the healing process, followed by tissue repair and remodel. Ice, however, inhibits this process.
First, ice causes vasocompression of blood vessels, shunting nutrients away from the area in need. This vasoconstriction has been shown to last long after the ice has been removed and can cause more tissue damage from lack of oxygen in the area.
Second, ice inhibits the release of IGF-1, a hormone essential for tissue healing.
Third, ice has been shown to actually increase swelling in an area by causing more lymphatic fluid to be released.
Lastly, ice has been shown to hinder sports performance including decreasing strength, speed, endurance, and coordination.
Stop icing your injuries...
The only time ice has been shown to be beneficial in the literature is in short durations (less than 10 minutes at a time) within the first 6 hours after an injury to help decrease some amount of swelling and pain. Any time after that first initial 6 hours, however, has been shown to have negative effects.
...and skip the meds
Another thing to note is that ice is not the only agent that decreases the body’s natural inflammatory response. Many medications including NSAIDs (such as ibuprofen) and cortisone also work to suppress the immune system, which in turn has been shown to delay healing.
What you should do instead
So, what should we do instead of icing? Research has shown that early movement is the best way to help recover from an injury. Range of motion, light strengthening, balance, and gait training are effective ways to start the healing process. We are not promoting heavy lifting or excessive training during this period. However, moving according to symptom tolerance helps restore normal function of the tissue, improve circulation, reduce swelling, and get you back to your normal activities faster. Stop icing your injuries, get moving, and recover quicker.
References
1. Dr. Gabe Mirkin. Why Ice Delays Recovery | Dr. Gabe Mirkin on Health. Drmirkin.com. Published September 16, 2015. https://www.drmirkin.com/fitness/why-ice-delays-recovery.html
11. Academy USS. The R.I.C.E Protocol is a MYTH: A Review and Recommendations. The Sport Journal. Published October 30, 2020. https://thesportjournal.org/article/the-r-i-c-e-protocol-is-a-myth-a-review-and-recommendations/
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