Most of us have had minor injuries in the past, be it from running, playing sports, or just living life; from my experience, what happens after the injury usually goes something like this:
“You know what you need to do- RICE”
“Don’t forget to ice and elevate”
“You’re going to have to rest and ice if you ever want to recover!”
You get the idea…
If you don’t know already, RICE is an acronym that stands for Rest, Ice, Compress, and Elevate. From pulled hammy’s to sprained ankles, it is far and away the most popular suggested treatment for all soft-tissue injuries.
The term RICE was crowned by a Dr. Gabe Mirkin in 1978, and if you’d like his take on the current paradigm, here is a link to his post on the topic.
Since the most important part of an injury is recovery, let me stop here and pose a quick question: have you ever wondered if performing the four parts of RICE is actually helping you recover faster?
This post is aimed at sheding some light on this fun and controversial topic.
First, Let’s break each part down individually:
Rest: Generally, this is where you are supposed to kick back and ‘let your body start to heal’. The thought here is that resting will decrease your risk for further injury and allow your injury to start healing on it’s own. Let me be the first to whole-heartedly disparage this myth, as more and more experts are supporting active recovery to improve healing time.
Ice: While you are resting, you are supposed to be applying ice about once or twice every hour to ‘keep the swelling down’, which undoubtedly speeds up the healing time, right? Wrong. While this is probably one of the hottest (pun intended) debates in the sports medicine community, there is no doubt that topical ice can help decrease pain. The raging debate is whether or not the inflammatory process following an injury is helpful or harmful. Many believe that decreasing the swelling will speed up the healing time. Many believe that the inflammatory process is part of healing, and limiting the inflammatory cascade might INCREASE healing time. Either way, topical ice is good for pain relief- that’s about it.
Compression: This is where you are supposed to wrap the injured area and keep compression on it so that it doesn’t get too swollen. Remember that inflammation argument with the ice? Yeah, it sort of makes this one confusing too. One thing is for certain: applying compression to an inured area is helpful at keeping it from swelling. The biggest question still lies in whether or not the swelling is helpful or not.
Elevate: This is the best part, because this is when you have doctors orders to kick back with you feet up- because it will “help you heal faster”. Anatomically, the idea here is to have your injured body part above the heart, to help the swelling drain back the heart. I think? Well, I’m not really sure, actually. While it makes sense anatomically, the better solution is movement of the muscles surrounding the injured area itself. You see, the venous and lymphatic system are dependent on muscle activation to act as a ‘pump’- which helps the old blood get back to the heart and lungs. There is even a theory that a group of muscle in the lower leg is known as the second heart, because of this exact reason
When you look at the different components of this widely accepted acronym, it’s easy to see why it is commonly recommended; it’s easy to remember and easy to follow. However, simplicity and best clinical practice generally don’t go hand in hand.
The underlying question of this post is whether the inflammatory process that occurs following an injury is good or bad. Due to complexity, I hope that I will be ble to address the answer to that question in a different post. However, what I’m suggesting has been written about extensively and I am by no means challenging something that hasn’t been challenged before. (here & here)
Unfortunately, the best way to recovery from your injuries depends on many factors; there is no one-size fits all solution.
So, if you believe recovering from an injury is important, please consider seeking professional help next time. And, if your practitioner doesn’t at least pause when you ask him/her about the RICE acronym, it’s probably time to find a new one.