R.I.C.E. for injuries: still a good idea?
The acronym R.I.C.E. has been used in physical therapy and injury management for decades to indicate the steps for immediate treatment of acute injuries. It stands for Rest, Ice, Compression and Elevation. Its origins can be traced back to 1978, with a publication titled “Sports Medicine Book” by Gabe Mirkin. Since then, these recommendations for acute injuries have been widely used by coaches and healthcare providers with the intent of speeding up the recovery process and reducing inflammation.
A re-evaluation of these recommendations is needed as Dr. Mirkin himself recanted his original position in 2015. Let’s go through it together.
Rest. Periods of rest following an acute musculoskeletal injury do not enhance the recovery process. The lymphatic system is responsible for draining the accumulation of waste products produced by the inflammatory process at the damaged site. The lymphatic system relies on voluntary contraction of the tissues surrounding the trauma to produce a propulsive force that flushes this waste out. Therefore, a period of stillness will not promote the evacuation and will instead congest the metabolic waste in the area, delaying healing.
Ice. Ice does reduce inflammation! But the inflammatory process is necessary to speed up the healing process and allow the tissues to regenerate. Inflammation is an essential aspect of recovery and should not be delayed extensively by applying ice to the injured area. Applying ice for 10 to 20 minutes, two to four times per day for the first two to three days after the injury can be helpful to reduce pain, but we should not rely on ice to improve injury recovery.
Compression and Elevation. This one is more of a “if it makes you feel better, why not?”. There is no definitive answer as to the contribution of compression and elevation for injury recovery, but it may help the injured feel better and tap into the placebo effect, so if you want to, do it. It is always important to make sure not to apply too much pressure and reduce circulation when compressing an injured area.
What should I do?
Active recovery appears to be the best strategy. Moving the body part early seems to help the injury by promoting lymphatic flow to remove metabolic waste and provide nourishment for healing. Pain free movement through a full range of motion as early as possible should be the goal for any acute musculoskeletal injury. Movements should be simple and the injured should progress gradually to higher intensities and more complex movements.
I cannot stress the importance of pain free and gradual progress enough: these are delicate times and in order to prevent re-injury, it is important to take the necessary time not to rush the recovery phase.
Additionally, we recommend to reach out to a healthcare professional for an evaluation of the injury in order to provide more personalized, case-specific support.