Woman in black using an ice pack on her arm due to pain while performing yoga
Many athletes with a history of sports injuries have heard the acronym of R.I.C.E. Rest. Ice. Compression. Elevation. This term has been used by throughout sports and physical medicine since it was coined by Dr. Gabe Mirkin in 1978. Anytime you've rolled your ankle, or had a sports injury, it's the first thing everyone tells you to do. It's easy, it's safe, but is it effective? The science doesn't necessarily back up what we at one time believed to be the best interventions in promoting healing of acute musculoskeletal injuries. In fact, many recommend reducing the amount of time spent icing and to begin rehabbing as soon as your body is ready.

Ice Reduces Inflammation

Inflammation gets a bad rap. Most of our traditional therapies are designed to knock down inflammation and swelling with anti-inflammatory drugs, ice, compression, etc. However, inflammation is a key component to the recovery process. While these strategies may reduce pain, they may also lengthen the amount of time it takes to recover after an injury.
Inflammation is a natural process that the body uses to not only protect an area, but to also promote healing in an acute injury. The "inflammatory cascade" is a process that brings swelling and cytokines to an area but also brings fibroblasts (which lay down new collagen fibers) and white blood cells (to clean up debris) to the injured tissues.
Relieving swelling through compression and elevation can be effective in many cases without inhibiting inflammation. They may even allow you to start moving the injured body part sooner.
Ice is good option as an analgesic (pain reliever). If short term pain relief is your biggest concern, then this may be a good option. But the idea that it will reduce recovery time is actually backwards. In fact, it merely delays the inflammation.

Optimal Loading - Active Recovery

Unloading an injured tissue for a short period of time is important to protect injured tissue. But this strategy should be of short duration and once it is safe to start moving it is important to do so in a way that will not do more damage.
Getting up and moving the injured area in a safe manner has shown to be a major component to returning to activity following a strain or sprain. An editorial in the British Journal of Sports Medicine was aimed to add optimal loading into the RICE protocol for soft tissue injuries.
Optimal loading is a term that revolves around applying mechanical stress to the joints, muscles, tendons, etc. through rehabilitation, exercise, and manual therapy. Optimal loading is a balance of loading and unloading tissues that promotes healing while also protecting the tissues in question. Each person responds differently to mechanical loading and programs should be designed on an individual basis. Progressing from low resistance to higher level activity is a key component to any rehabilitation program.
Minor injuries may begin the rehab process within 24 hours while others may need more time to recover before loading can begin safely.

So What?

Using the R.I.C.E. protocol is a very safe method of dealing with acute soft tissue injuries such as sprains and strains. However, it is not going to help you recover faster. If you have ambitions of getting back on the field sooner or back to 100% you should consult with a trusted healthcare provider to come up with a personalized rehab plan for recovery. Always consult with a healthcare professional prior to engaging in any rehab activities.
Dr. Courtney Means

Dr. Courtney Means


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