Could R.I.C.E. be wrong?
Pretty well every athlete knows about RICE. RICE stands for rest, ice, compression, elevation, and it has been the the SOP (standard operating procedure) when it comes to the treatment of acute injuries for decades.
The question is do current medical studies still support the RICE protocol? Let’s investigate.
The question is do current medical studies still support the RICE protocol? Let’s investigate.
How is RICE supposed to work?
Based on new research, Dr Mirkin is reconsidering RICE as a sports injury treatment. Reported in the American Journal of Sports Medicine in June of 2013, in the study athletes exercised so intensely they developed enough muscle damage to cause extensive muscle soreness. In treating the athletes with ice, researchers found that, although cooling delayed swelling, it did not speed up recovery. Why? Here is the current thinking:
The body needs inflammation to heal. Interestingly, your body uses the same cells and proteins to heal an injury as it does to kill germs. These inflammatory cells, bring a hormone called Insulin-like growth Factor (IGF-1) to your injured tissues, to help them heal. Applying ice to limit swelling prevents your body from releasing these IGF-1 cells - delaying healing - the exact opposite of what you intended.
Another impact of applying ice to injured tissue is it can cause blood vessels near the injury to constrict and shut off the blood flow. Not only does that hinder the healing cells from coming to the rescue, studies also show the blood vessels may not open again for many hours afterwards, causing the tissue to die and nerves to become damaged.
In fact, anything that intervenes with your immune response could delay healing. Cortisone-type drugs, most pain-relieving medicines, immuno-suppressants, and cold packs or ice, are now all suspect when it comes to a speedy recovery from an injury.
The body needs inflammation to heal. Interestingly, your body uses the same cells and proteins to heal an injury as it does to kill germs. These inflammatory cells, bring a hormone called Insulin-like growth Factor (IGF-1) to your injured tissues, to help them heal. Applying ice to limit swelling prevents your body from releasing these IGF-1 cells - delaying healing - the exact opposite of what you intended.
Another impact of applying ice to injured tissue is it can cause blood vessels near the injury to constrict and shut off the blood flow. Not only does that hinder the healing cells from coming to the rescue, studies also show the blood vessels may not open again for many hours afterwards, causing the tissue to die and nerves to become damaged.
In fact, anything that intervenes with your immune response could delay healing. Cortisone-type drugs, most pain-relieving medicines, immuno-suppressants, and cold packs or ice, are now all suspect when it comes to a speedy recovery from an injury.
In 1978, Dr Gabe Mirkin coined the term RICE, and promoted its use for the treatment of athletic injuries. Since then, it has been used to help accelerate healing and injury recovery by easing pain, and decreasing inflammation and swelling at the site of the injury.
What’s going on under the surface?
When tissues of the human body have been injured, they go through three distinct phases of healing:
1. Inflammation. During this phase, blood, dead cells and fluids known as exudates build up. This triggers inflammation cells to be sent in for clean up. Inflammation triggers a release of growth hormones that help to stimulate further healing. This stage is an essential phase of healing.As you can see, the remarkable human body has the ability to heal itself.
2. Proliferation. Next, inflammation creates a chemical response that triggers a release of fibroblasts. Fibroblasts are cells that are found in connective tissue. They are rich in collagen and known to promote healing. While this is occurring, blood flow to the area is increased, helping to maximize healing by allowing oxygen and nutrients to remove metabolic waste products.
3. Remodeling. This is the scab and scar phase. To repair the wound, collagen is laid down, reabsorbed, and replaced by stronger collagen which, eventually, forms scar tissue. While scars are part of the healing process, they can lead to loss of function and other problems.
1. Inflammation. During this phase, blood, dead cells and fluids known as exudates build up. This triggers inflammation cells to be sent in for clean up. Inflammation triggers a release of growth hormones that help to stimulate further healing. This stage is an essential phase of healing.As you can see, the remarkable human body has the ability to heal itself.
2. Proliferation. Next, inflammation creates a chemical response that triggers a release of fibroblasts. Fibroblasts are cells that are found in connective tissue. They are rich in collagen and known to promote healing. While this is occurring, blood flow to the area is increased, helping to maximize healing by allowing oxygen and nutrients to remove metabolic waste products.
3. Remodeling. This is the scab and scar phase. To repair the wound, collagen is laid down, reabsorbed, and replaced by stronger collagen which, eventually, forms scar tissue. While scars are part of the healing process, they can lead to loss of function and other problems.
What’s wrong with RICE?
So now what?
If you injure yourself, stop what you are doing ASAP. Elevate the injured part of your body to reduce swelling, and seek the attention of someone trained to treat sports injuries.
If your injury is severe, ie:
we recommend you head straight to the emergency room. Remember also that open wounds need to be well cleaned, and x-rays are often a good idea to rule out broken bones.
Since ice does help relieve pain, it can be used briefly immediately after the injury occurs. Ice on for 10 minutes, and off for 20, one or two times should be all the cooling you do.
As for rehab, be sure to follow your doctor’s advice. If your injury is minor, you should be able to begin rehabilitation as soon as the next day as long as it does not cause increased pain. Our bodies were meant to move so, get going as soon as you can - as long you make sure you stick to pain-free movement.
If you would like to learn more about this new thinking around the use of RICE, please check out these articles:
http://drmirkin.com/fitness/why-ice-delays-recovery.html
http://www.caringmedical.com/sports-injuries/rice-why-we-do-not-recommend-it/
http://www.mobilitywod.com/2012/08/people-weve-got-to-stop-icing-we-were-wrong-sooo-wrong/
If your injury is severe, ie:
- there is lots of pain
- you lost consciousness
- you can’t move
we recommend you head straight to the emergency room. Remember also that open wounds need to be well cleaned, and x-rays are often a good idea to rule out broken bones.
Since ice does help relieve pain, it can be used briefly immediately after the injury occurs. Ice on for 10 minutes, and off for 20, one or two times should be all the cooling you do.
As for rehab, be sure to follow your doctor’s advice. If your injury is minor, you should be able to begin rehabilitation as soon as the next day as long as it does not cause increased pain. Our bodies were meant to move so, get going as soon as you can - as long you make sure you stick to pain-free movement.
If you would like to learn more about this new thinking around the use of RICE, please check out these articles:
http://drmirkin.com/fitness/why-ice-delays-recovery.html
http://www.caringmedical.com/sports-injuries/rice-why-we-do-not-recommend-it/
http://www.mobilitywod.com/2012/08/people-weve-got-to-stop-icing-we-were-wrong-sooo-wrong/
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