“Make sure to put some Ice on that.”
One of the most common things heard from athletes, trainers, and healthcare professionals alike when it comes to pain, injuries, and sore muscles.
The management of injuries ingrained in our society: Rest, Ice, Compress, Elevate or more simply known as RICE.
Please STOP doing this!
Origins of RICE:
RICE was originally coined in 1978 by Harvard physician Dr. Gabe Mirkin with the intent to minimize inflammation and decrease pain to accelerate the healing process.
Thankfully the way we treat injuries, pain, and soreness has continued to evolve and improve.
In 2014 Dr. Markin retracted his own approach to injuries stating:
“Subsequent research shows that ice can actually delay recovery. Mild movement helps tissue to heal faster, and the application of cold suppresses the immune responses that start and hasten recovery. Icing does help suppress pain, but athletes are usually far more interested in returning as quickly as possible to the playing field. So, today, RICE is not the preferred treatment for an acute athletic injury.”
To understand why let’s take a look at the main reasons for using ice and why it is not the right approach for:
And what a better option might be.
Ice and Pain Relief:
There is no doubt that ice specifically reduces pain. This is due to the fact that pressure, temperature, and pain all run up the same pathway to the brain.
Essentially your brain can only feel one thing at a time.
This is something that we take advantage of naturally, ever hit your funny bone and start rubbing it?
But the question is, is the cost of pain relief worth it?
Is pain really the enemy? We answer that questions HERE
Pain is an alarm signal asking you to change something, much like a check engine light.
If you cover up the check engine light with your hand or some tape does that make the problem go away?
The same result can occur from use of ice or pain medications post injury.
It is important to take pain for what it is and respond to it.
The cost of the use of ice? Delaying healing in the form of inflammation.
Ice and Inflammation
What are the three phases of healing?
Inflammation > Repair > Remodel
That’s right, inflammation starts the healing journey and is not inherently a bad thing!
When we experience pain our body uses macrophages (inflammatory cells) to kill off damaged tissue that also sparks the release of the hormone IGF-1 (Insulin-like Growth Factor) that starts repairing the damaged area once the region is clear.
Ice slows this process down.
You want healing factors to approach the area of pain just like you want paramedics to make it to the scene of an accident, and without delay!
But, is too much of a good thing a bad thing?
This leads us to swelling.
Ice and Swelling
When the inflammatory process starts it clears the way for more help by dilating both the lymphatic and circulatory (arteries and veins) system.
Using our paramedic example this is essentially getting rid of the traffic completely.
When a lot of fluid rushes into an area, as it often does with injuries and pain, we get … swelling.
Now excessive swelling is bad and is often referred to as edema.
We cleared traffic for the paramedics but the traffic behind the accident is not moving at all, and having a negative effect.
Edema can create unwanted pressure on the tissues, restrict movement, increase pain, and decrease muscle function, all of which can increase edema more and the cycle can repeat itself.
Ice will slow this from happening, but there is a much better option.
Our body uses muscle pumps to help expel fluid from a region. Essentially this helps clear the damaged materials that are being killed off, much like removing the car parts from an accident off the road so traffic can get moving again.
This is why rest has also been completely removed from recommendations of injury and pain management as well!
What Should You Do?
When it comes to RICE the main question is, “Is the brief reduction in pain relief and swelling worth it?”
Most of the time the answer is quite simply, no.
In 2019 a new and more comprehensive management for pain and injury was released to reflex our increased care.
Protection, Elevation, Avoid Anti-Inflammatory Drugs, Compression, Education & Load, Optimism, Vascularisation and Exercise
PEACE & LOVE
This is the exact approach we take to each of our patients' individualized situations.
You do not need rest.
You do not need to cover up the pain (with ice or anything else).
You need to respond to the signals your body is giving you.
You need to act! And you'll need the support of a modern times educated physical therapist.
Click HERE to set up your 15 minute phone consultation with a Specialist to see how we can help!
🚫The content in this is NOT medical or health advice and is intended for educational and entertainment purposes only. See a healthcare professional if you have any questions about your individual healthcare needs.🚫
Dubois, B. & Esculier, J-F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine. 54, 72-73.
Mirkin, G. & Hoffman, M. (1978). The sportsmedicine book. (1st ed.). Little Brown and Co.
Reinl G. Iced! The illusionary treatment option. 2nd Edition. Gary Reinl. 2014.
Scott, A., Khan, K. M., et al. (2004). What do we mean by the term “inflammation”? A contemporary basic science update for sports medicine. British Journal of Sports Medicine. 38, 372–380.