Why its time to stop using the R.I.C.E method for injury and pain

​We are all probably aware of the R.I.C.E (Rest, Ice, Compression, and Elevation) method used for pain and injuries. In this article I am going to look at how the latest research shows us that this method probably isn’t as effective as we thought it once was and will also show you what method we would be better off using.

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Where does R.I.C.E come from?
Rest, Ice, Compression & Elevation came from Dr Gabe Mirkin in his 1978 Sportsmedicine book. Since then it has become standard practice on the majority of first aid courses and the go to for any injuries/accident. Now the man himself, Dr Gabe Mirkin has come out and said “now it appears that ice and complete rest may delay healing, instead of helping”.1

What is wrong with ice?
“Almost no evidence that ice and compression hastened healing over the use of compression alone, although ice plus exercise may marginally help to heal ankle sprains”.
 
When you get injured you body actually needs inflammation to start the healing process, but applying ice to reduce swelling actually delays the healing by preventing the body from releasing IGF-1 (IGF-1 is  hormone which the inflammatory cells release into damaged cells to promote healing). 1.

Ice can be used short term to reduce pain, not swelling
Ice has been shown to reduce pain, so it may be a good idea to use it initially but only to get the pain sensation down, not to reduce swelling (we know that is not likely to work, or could even make things worse). Longer periods of using ice can also effect ones speed, strength, endurance and coordination (Sports med, Nov 28, 2001). Dr Gabe Mirkin recommends “You could apply ice for up to 10 minutes, remove it for 20 minutes, and repeat the 10 minute application once or twice. There is no reason to apply ice more than six hours after you have injured yourself”. 1.

Why we shouldn't rest for too long
We have seen above why using ice (especially for long periods) is detrimental to healing. Rest is also good for short periods in the initial stages are advisable, but again this should only be short term as resting for longer periods can also be detrimental. Research from the British journal of sports medicine says “Rest should be of limited duration and restricted immediately after trauma. Longer periods of unloading are harmful and produce adverse changes to tissue biomechanics and morphology”. 2 

What should we do instead?
Call the P.O.L.I.C.E (Protection, Optimal Loading, Ice, Compression, and Elevation)

• Protection – Stop exercising immediately, after the injury, ensure we protect it as to not cause further damage. If pain is serve pain, lose of consciousness or confusion occurs it is vital to check for a medical emergency. Carry out usual checks for bone breaks, open wounds and ensure movement won’t increase damage.

• Optimal Loading - as mentioned above “Longer periods of unloading are harmful”. Mirkin suggest that “minor injuries, you can usually begin rehabilitation the next day”. Moving and using the injured area without increasing pain and discomfort.

• Ice – As mentioned above, good to reduce initial pain but not to use long term.
• Compression – Can be used in the short term to ensure injury doesn’t get worse in the initial stages, but ultimately we want to be moving as soon as comfortable.
• Elevation – Again good in the initial stages to prevent the injury getting any worse, but should only be used short term.

Sources

1. Dr Gabe Mirkin, September 15 2016 Why ice delays recover, www.drmirkin.com/fitness/why-ice-delays-recovery.html, accessed 26/01/19
2. C M Bleakley, P Glasgow, D C McAuley, September 7 2011, Price needs updating shall we call the POLICE? available at: bjsm.bmj.com/content/46/4/220.infoo, accessed 26/01/19

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About the author
I am a Manual Therapist covering a range of different disciplines including massage & Biomechanics. I also run small specialist Pilates classes around Corfe Mullen, Broadstone, Wareham, Wimborne & Poole. Instead of just purely rubbing the pain, I always look to see if I can find a potential cause (or causes of the pain) and then work on treating this