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RICE is DEAD

by Dr. Jason Barker April 28, 2022

RICE is DEAD


In 1978, the term R.I.C.E was coined by Dr. Gabe Mirkin in his book, The Sportsmedicine Book.

RICE is an acronym for treatment of athletic injuries - Rest, Ice, Compression and Elevation.

Accepted as gospel for treating injuries in the sportsmedicine world for decades; some aspects of this directive came under question beginning in the late 90’s.  Even so, we’re 2 full decades out and RICE is still widely recommended despite a large amount of research that refutes its utility in healing injures - even Dr. Mirkin has refuted part of his original RICE guidelines. 

Here’s what’s new in the treatment of athletic injuries:

Ice Is Out

The cooling effect of ice will undoubtedly limit swelling, yet it will not enhance recovery time (read: healing) (1).  Here’s what ice does, however.  Cooling causes blood vessels to constrict, essentially cutting off the flow of fresh blood into, and waste-laden blood out of, injured areas.  It also inhibits the release of the body’s orchestra of inflammatory chemicals that initiate and carry out the healing process, put very simply.  YES, you need inflammation to heal! There’s a difference between acute inflammation (good) and chronic inflammation (bad), generally speaking.

Rest Is Out, Movement Is In

Once a fracture or other severe injury (full tears) are ruled out, movement is advised, rather than rest. When the body moves, blood flows. Blood brings oxygen, nutrients and removes metabolic waste from the injury site.   As tissue is moved (muscles contract, elongate and compress) growth factors are released; stimulating protein synthesis in muscle, tendons, ligaments, cartilage and bone.

At rest, this activity is stunted and healing is delayed.  Immediate, yet gentle movement through a functional range of motion is where it’s at now.

What About Compression and Elevation?

Compression is meant to limit swelling.  It accomplishes this by squeezing blood vessels so that blood flow into and out of an injured area is limited.  Although difficult to study, we’re back at a similar problem with using ice - blood delivery and return is limited with compression, and may therefore delay healing.  Compression does, however improve “quality of life” - meaning that a compression wrap can make an injured body part feel more secure and protected. So, nothing wrong with that. 

However, our advice is to limit compression to times when an injured area may be at risk of being bumped or jostled (such as during travel in a car, or during sleep).  Otherwise, it’s probably best to allow the blood to flow in and out of the injured area as freely as possible.  Don’t forget the pumping effect that moving muscles will have - moving the part surrounding an injury (within pain tolerance) will create a similar benefit to compression but without the stagnation of blood in the area.

Elevation allows gravity to limit swelling.  Again, nothing wrong with this. In fact, elevation can certainly improve that quality of life score as well.  The body is excellent at repairing injuries and creating swelling - with this comes a lot of discomfort.  Elevate if it makes the injury feel better.

alternatives to RICE therapy

What About AntiInflammatories?

Use caution.  NSAIDs are great at relieving pain, but there’s no evidence they enhance healing, and in fact there’s evidence they delay tissue healing (2) may inhibit cartilage repair (3) and can damage the kidneys (4).

You can read more here

A variety of botanical medicines exert equally powerful anti-inflammatory effects without these side effects. 

In clinic, we recommend the following for athletic soft tissue injuries:

 

Inflammation Relief  contains systemic enzymes that help speed healing by breaking down pain-generating and inflammation-producing chemicals in the injured tissue. Enzymes can also improve oxygen and nutrient delivery to the injured area.

Curcumin Relief  Curcumin is a powerful, natural anti-inflammatory derived from the herb Turmeric.  Curcumin Relief is made of a highly absorbable form of curcumin - it’s one of the strongest natural anti-inflammatories known!

Ligament Restore   contains the amino acids, collagen, and vitamins that serve as the building blocks for repair of tendons and ligaments. It also contains pain-relieving botanical medicines.

RICE is out, but movement, increasing blood flow and tissue support are in.  As soon as the injury allows, light duty therapy and movement exercises should begin with a gradual return to practice as soon as pain is minimal and strength has returned.

Healing guidelines for specific types of injuries can be found here.

 

References:

1. Bleakley, et al. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sports Med Jan-Feb 2004;32(1):251-61.

2. Anderson K, Hamm R. Factors That Impair Wound Healing. J Am Coll Clin Wound Spec. 2012 Dec; 4(4): 84–91.

3. Shield MJ. Anti-inflammatory drugs and their effects on cartilage synthesis and renal function. Eur J Rheumatol Inflamm 1993;13(1):7-16.

Dr. Jason Barker
Dr. Jason Barker


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