THE MYTH: Any time you sustain an injury or have pain in an area, the old acronym R.I.C.E. (Rest, Ice, Compression, Elevation) will help the healing process and get you back in the game as quickly as possible.
THE REALITY: R.I.C.E. is an antiquated methodology that often does more harm than good.
At The Mobile Athlete we take an active approach to care. We really do believe, and (the research agrees) that movement is medicine. Our job is to keep you in the game and not take you out.
Rest: A Double-Edged Sword
Don't get me wrong: it's not advisable to run or compete immediately following a major injury (something like a hamstring avulsion, tibial stress fracture, or torn meniscus) but it's also not advisable to stop loading those structures all together, even it it causes discomfort. To be honest, most injuries are far less severe than the ones I just mentioned.
We almost never tell someone to stop moving completely unless the injury is extremely severe; even then, I advocate for a rehab plan that includes loading the tissues and tendons.
Prolonged immobilization can lead to muscle atrophy, joint stiffness, and decreased functional capacity. In most cases, controlled movement and gradual loading are more beneficial for promoting healing and preventing de-conditioning.
Even Dr. Gabe Mirkin, who first coined the R.I.C.E. acronym in 1978, recanted his position on rest (and ice) in light of an onslaught of evidence showing that it actually causes delay in healing.
Ice: More Harm Than Good?
Research shows ice can cause decreased release of IGF-1 (a growth factor released by macrophages to help “clean up” damaged tissue); constriction of blood flow to the injured area (the effect we THOUGHT we wanted but now realize can be damaging, especially if ice is used on an area for more than 20 minutes); and reduction in strength, speed, power, and agility immediately after use.
Imagine this scenario: An injured athlete sits on the sideline with a huge ice pack on his knee until it’s numb enough to get back in the game. He re-enters the match with decreased coordination and agility, which is a recipe for disaster when it comes to sports like soccer, football, rugby, and pretty much everything else involving lateral movement.
I could nerd out on this more because I want our athletes to get the best, most progressive care possible.
Compression: Too tight for too long is no good.
When you sustain an injury your body's natural response is send all of your injury fighting cells (macrophages, neutrophils) to the sight of the injury. For these cells to get to the injury, they have to travel in a river of fluid. The arrival of fluid and injury-fight cells to site of the injury leads to swelling... also known as inflammation.
Inflammation is an essential part of the recovery and healing process. We need to continuously bring macrophages and neutrophils to the injury so they can heal and repair. AND we need to allow the waste products produced by these healing cells to be drained away by our lymphatic system.
If we wrap that injury tighter than Christmas present then we are slowing down the arrival of injury-fight cells and we are slowing down removing the debris and waste products from the injury.
Wrapping an injury for a short period of time to stabilize and the structures is totally reasonable. But it is important to avoid excessive pressure, which can restrict blood flow and impede healing.
Proper compression techniques and appropriate timing are crucial to maximize benefits and minimize risks. Find a professional to help you!
Elevation: Why so high?
The old mentality around elevation was to try elevate the injury above the heart to allow for the fluid to drain back in to the system.
Well...just like we discussed with compression, inflammation is essential an essential part of the recovery process.
Yes, elevation can help reduce swelling, but it is not always necessary and may not be practical in all situations.
Over emphasis on elevation can delay early movement and activity, which are essential for optimal recovery.
If you have made it this far you might be asking yourself "if RICE is out dated...what to I do instead?"
Great question! We will cover that future blog! But to give you a hint, its called active recovery. With active recovery, we prioritize early movement, control loading the tissues and provide targeted interventions.
There is a lot of noisy, distracting and conflicting information floating around. If we can ever help clarify and distill down that information just reach out.
If we can help you navigate through recovering from an injury the best way possible, reach out. We are always here to help!