Breaking the Ice: Dispelling the Myths about using the ‘RICE’ Method for Healing an Injury
By: Kelsie Mazur, DPT
Attention! It’s time I address the elephant in the room: RICE. No, not the grain...I’m talking about the acronym RICE: Rest, Ice, Compression, Elevation, often recommended after an acute injury like an ankle sprain. If you were to ask anyone on the street, sadly even some physicians, about handling sprains and strains, chances are they'd chant "Rest, Ice, Compression, Elevation." I've heard countless stories of folks with hamstring strains or ankle sprains hitting pause on their gym sessions, immobilizing themselves, taking time off work, only to find their injuries lingering. Eventually, they return to their activities, only to face another injury. But why does this cycle persist? Let's delve deeper into the matter.
History of RICE
Since 1978, the RICE acronym has been the standard approach for treating acute injuries. HOWEVER, it might actually hinder your overall recovery and postpone healing. Dr. Gabe Mirkin introduced the term RICE, but he later retracted his original statement in 2014, citing insufficient evidence and acknowledging inflammation as a crucial aspect of the healing journey. Whoops! Like fashion trends, our understanding evolves, highlighting the importance of staying up-to-date of the latest research as we accumulate more long-term data. Ice (I in RICE) was originally claimed to "reduce inflammation" and speed up recovery in the short term, BUT inflammation is a part of our body’s natural healing process, and we don’t want to halt it. That would be like preventing EMS and First Responders from rushing to the scene when there’s a car wreck- not ideal.
Additionally, long periods of rest (R in RICE) for soft tissue injuries (strains and sprains) are also shown to delay recovery and set you up for re-injury, as rest weakens tissues and can lead to problems down the road. Definitely don’t want to get trapped in this frustrating cycle.
The Takeaway:
There is a TON of evidence that loading and moving injured tissues ASAP actually accelerates healing. In fact, there was research by two doctors as early as 1996 in which they tried to replace RICE with MICE, the M meaning MOVE. The takeaway? Patients should start initiating movement as tolerated post-injury, “Once fracture or catastrophic injury is excluded: movement is best, not rest, to treat an injury...[including] immediate but gentle restoration of active range of motion with gradual introduction of functional activities” (Robinson 2017).
Take this example: Consider an athlete who sprains their ankle and receives clearance from a fracture. Instead of immobilizing and icing the ankle, as the Physical Therapist, I would initiate gentle active range of motion exercises and introduce weight-bearing activities, within the pain threshold. This approach aids in early normalization of gait patterns and gradually exposes tissues to loading, thereby desensitizing the brain to the
injury. Of course, the amount of movement and loading is going to be dependent on the injury and the person. This is where working with your Doctor of Physical Therapy at Wattage can be helpful in monitoring and applying appropriate loads based on your body’s responses and stages of healing. Our bodies are remarkable. Let's refrain from seeking quick-fix solutions for injuries!
Injury is a natural aspect of life, and our bodies have built in machinery to help us bounce back from them; inflammation and movement are just two of them. Let’s use ‘em!
So When Should I Ice?
Following an acute muscle strain or tissue sprain, it's important not to stop all movement and try to refrain from immediately applying ice. Instead, seek out safe and manageable ways to mobilize the injured area, gradually introducing progressive loading. Begin with caution and gradually increase intensity over time. If neither of these are working for you, consult a physical therapist for evidence-based advice on next steps.
The takeaways...
Inflammation is a natural part of the healing process.
Rest and ice may not be helping your recovery from acute injuries - they actually may be delaying it!
Continue to move and load in a tolerable range after acute injury. Motion is your friend!
If ice is the ONLY thing that is helping your unbearable, immobile, SEVERE pain, then use it, but use it sparingly in 10 min increments.
See Kelsie at Wattage for all your aches and pains :)