Injuries are a part of life, and they can happen to anyone. Whether you are a professional athlete or a weekend warrior, you need to know how to treat your injuries properly. One common treatment for injuries is to apply ice to the injury. However, recent research has shown that icing an injury may not be the best solution. In this blog post, we will explore why icing an injury might not be the best option and what you can do instead to promote healing and recovery.
What Is RICE?
RICE is a protocol that was developed by Dr. Gabe Mirkin in 1978. As a result, this has been the default injury management technique used for over 40 years. RICE (rest, ice, compression, elevation). The concept behind RICE is that it reduces inflammation after an injury. This assumes that, even if RICE does what it claims (it doesn’t) that inflammation is a bad thing and that we should make every attempt to reduce it. Additionally, Dr. Mirkin recanted his statement on using the RICE principle in 2015.
No. Ice does not, never has and never will reduce inflammation. We desperately need to get out of this line of thinking from the 20th century. Ice cause vasoconstriction. This decreases blood flow. If you were to take a running hose and clamp it off, would water be able to get thought it? Of course not. But somehow we think this same concept will reduce inflammation.
Furthermore, why do we want to reduce inflammation? Inflammation after an injury is not bad. In fact, inflammation is the first part of the healing phase and is REQUIRED for tissues to heal. Why would you want to reduce inflammation (which ice doesn’t even do) much less delay it? By delaying inflammation, which ice does, you delay the healing process. If you want to recover faster from an injury you should never use ice. Read more about this here.
The concept of resting an injury is to prevent further trauma to the injury. While the concept may make sense at a surface level, the actual tissue response is a negative. The body adapts to any force, or lack thereof, applied to it. Therefore if you rest an injury, the response will be a decrease in ROM as well as weaker tissue.
The proper response in an acute injury is to move and load the damaged tissue as much as tolerable. This will look vastly different from injury to injury and person to person. Regardless of injury and injury severity, there is also some exercise that can be done. Here is an example of what you would want to do for an ankle sprain as an alternative to rest (LINK)
The most egregious principle of RICE. Before we discuss ice we need to briefly understand the healing process. When there is an injury to any tissue, the response of the body is inflammation. This is the first phase of the healing process. An injury cannot heal without inflammation. This is not something that you want to reduce (which ice doesn’t even do) acutely. Icing an injury is never the play IF optimal healing is the goal
Now lets discuss what ice actually does. Ice cause vasoconstriction (blood vessels shrink). This means that there is a decrease in blood flow. Imagine that you had a hose and clamped it off. How would that get the water from one end out? Same concept applies to icing an injury. The only thing that ice does is delay inflammation. Given that inflammation is needed to heal, this delay means you are slowing down your body’s ability to heal.
The old recommendation was to apply an ace wrap to an injured body part. The wrap was applied so that it was tighter close to the injury and got looser as you moved away from the injury. Remember, this is done in conjunction with ice so all you do is reduce blood flow which is the last thing you want.
Compression has merit when it is done actively via pneumatic compression. However, this is done to improve blood flow and is not done as an acute intervention as you do not want to move inflammation out in the acute phase.
Using gravity is one of the methods that actually works to improve lymphatic drainage (reduce swelling). However, this is not something you want to do in the acute phase, again as you NEED inflammation. When you get past the acute phase, and have some chronic, pitting edema, then doing exercises with the body part elevated is warranted.
When Is Icing An Injury Ok?
Alright, time for some nuance.
Yes, if you want to heal an injury with optimal healing you should not use ice. However, there are times when ice has merit. Ice is an incredibly cheap and effective pain killer.
In the event an athlete has a major injury (fracture, major soft tissue injury) the main goal is pain reduction. Whatever time you lose in terms of ideal healing does not come close to the total time its going to take to recover
If a kid pops his ACL, they’re gonna miss 9-12 months. Whatever delay in healing you add, won’t even make any tangible difference. Ideally you would not use ice but that alternative is to leave a kid laying on a table in tears. Not a good look. Also, ideal does not exist in real life.
Yes there are some more examples but they are incredibly specific and are far and away the exception.
Quick takeaways from the RICE principle:
- Rest makes you weaker and makes rehab harder
- Ice delays healing
- Compression and elevation can reduce swelling but you do not want it reduced acutely.