Reconsidering RICE
for Injury Recovery
There is so much to do here in Alaska for those of us inspired
to go outside and play. Many of us play too hard, too fast, and get ourselves
injured. I always preach/advise
to train in smaller versions of the play you plan on doing to prevent injuries.
That’s a lot easier said than done when you have cabin fever. By the fall half
of my family, and most of my friends, are nursing injuries of some sort.
For injuries that don’t land us in
the ER, the gold standard for treatment for the last 30 years has been RICE: Rest, Ice, Compress, and Elevate. Today
many professionals believe clinical evidence doesn’t support the practice. Even
the researcher who originally championed the regimen, Gabe Mirkin, has come out
to denounce his previous conclusions as flawed. (Mirken, G. 1,2) I moved away from it a few years ago in my practice, and
have had improved outcomes. It’s been nice to have strong science to back up my
clinical observations. There are various new acronyms jockeying for
favor, even one called
MEAT, but none that are sticking like RICE did.
Not
everything has changed. Compression and elevation are still good. Just
keep the compression light, so you don’t compromise circulation. The biggest
changes in advice involve Rest and Ice.
By Rest we mean;
Stop doing what got you injured. Many
apply Rest by immobilizing or not
using their extremity for days. This rest causes weakness and stiffness. In
comparison studies, people who move recover sooner than people who rest. We
recommend progressive movement, within any range of motion you have that
doesn’t aggravate your pain. People who
can’t move actively, we’re moving passively.
Movement, combined with elevation
is excellent at improving circulation and reducing edema. It is what I do treat swelling in my
post-operative patients. Move, then use, then strengthen; as sensibly
and as soon as you can.
The most controversial recommendation
is the advice to stop using Ice to
treat inflammation. The argument is that we don’t want to treat the
inflammation, because inflammation leads to healing. If we stop one “domino”,
we stop the cascade. The clinical research seems definitive that healing is
inhibited and slowed when ice is applied. Icing to get back into a game is not
recommended either. It reduces, strength, speed, endurance, and balance; which
increases injury risk. (4,5,6,7,8)
What ice is good at is numbing. So
now we/you have to
balance your desire
for numbing your injury, and your goal of recovery. There are times that all of
us will pick numb. An ice pack for 10 minutes on, 20 min off for the first few
hours is optimal. Even contrast baths (ice then heat) have not shown any
efficacy to reduce swelling or speed healing. (9,10) However, I find it a convenient tool for torture.
After 48 hours, I recommend heat
for managing pain. Heat actually
has a long history of use to speed healing and manage pain in scientific
literature, and in traditional medicine. Adding heat does not trigger,
or inhibit the complex cascade of inflammation. It does increase blood flow, which
provides nutrients to assist with healing. Along with reducing pain, it
increases range of motion and mobility. I see its benefits on a daily basis.
You should check in with a health care provider for an
assessment if you aren’t getting better in a week or two, whether you
are sticking with RICE, or living on the edge with me. I am sorry to say, I don’t have an acronym that will help you
remember the recommended changes, but I trust we will heal faster if we just
“let it go.” (Some ice and
movie reference intended.)
Authors note-( if you want to have some sort of
disclaimer) You will find a lot of
information that contradicts the findings here. That information is based on
text books that are decades old, and advice based on decades old theories that
have been disproved in application. This advice here has been gleaned from the
last 10 years of research in professional medical and sports journals. Persons
who want to research the latest information further, can easily do so.
References
1. Mirkin
G. Why Ice Delays Recovery. March 16,
2014. http://drmirkin.com/fitness/why-ice-delays-recovery.html.
Accessed 7/26/2014 *
2. Mirkin
G, Marshall H. The Sports Medicine Book.
Little Brown and Co. 1978 *
3. British Journal of Sports Medicine. Cooling an acute muscle injury: can basic
scientific theory translate into the clinical setting? Mar
2012, Vol. 46 Issue 4, p296 3p. *
5.
Med Sci Sports Exerc. Microvascular
perfusion and intramuscular temperature of the calf during cooling. May
2012 44(5) *
6. American Journal of Athletic Training. What is the evidence for rest, ice, compression, and elevation therapy
in the treatment of ankle sprains in adults? 2012;47(4):435–443.*
7. Journal of Strength and Conditioning
Research.
Topical cooling
(icing) delays recovery from eccentric exercise-induced muscle damage. 2013 May;27(5):1354-61. *
8.
Athletic Training & Sports Health
Care: The Journal for the Practicing Clinician Nov 2012, Vol. 4 Issue 6, p247 2p.
9.
Physical Therapy Journal. Comparison of Three Treatment Procedures for Minimizing Ankle Sprain
Swelling.1988; 68:1072-1076.
10. American Journal of Hand Therapy. A systematic review of the effectiveness of contrast baths.
2009 Jan-Mar;22(1):57-6
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