R.I.C.E. Treatment is Outdated...aka STOP ICING!

Have you ever used Rest-Ice-Compression-Elevation (R.I.C.E.) to treat an injury before? If you answered yes, you’re not alone. R.I.C.E. was coined by Dr. Gabe Mirkin in 1978 as a treatment for athletic injuries, as ice provides great pain relief; it has been a standard treatment for athletic injuries and sore muscles ever since. But it turns out this may not have been the best advice after all, as both ice and complete rest have been proven to delay healing, instead of helping. (Even Dr. Mirkin has since changed his recommendations.)

Healing actually requires inflammation. When tissue breakdown occurs from either a hard workout or injury, inflammatory cells are sent to the region to start the healing process. These cells release Insulin-like Growth Factor (IGF-1) in the damaged tissues to stimulate them to heal. When ice is applied, it prevents IGF-1 from being released which delays the healing process. Ice also causes vasoconstriction of the blood vessels in the region, causing a slowing of blood flow which further decreases the amount of healing cells that can reach the area. These blood vessels do not open fully again for several hours after the ice is removed. Other than also delaying healing, this can cause the tissues to die or cause nerve damage in extreme cases.

Ice will also decrease your speed, coordination, strength, and endurance (Sports Med, Nov 28, 2011). Ice has been used as a short-term treatment to get an injured athlete back into a game, but will cause a significant decrease in performance and increases the risk of greater injury if a re-warming period isn’t used. The authors recommend that if cooling is done to limit swelling, it should last less than 5 minutes, and must be followed by a progressive warming period prior to returning to play.

What should you do instead?

Compression and limited elevation are still good recommendations for excessive swelling in an area from an acute injury. I recommend using a VooDoo wrap for short, intense compression or an ace bandage or compression garment for more prolonged wear. Rest has been changed to movement, focusing on small, low-load movements to the region to encourage new tissue growth in an organized fashion and enhance flushing of lymph and blood to remove debris and bring in new, nutrient-rich blood. Movement should be gentle and within your pain tolerance, but performed as often as possible. 

If you must use ice for its pain-relieving properties, use it as a hot-cold pump instead of a prolonged treatment. Place the ice on the area for less than 5 minutes (cold), then take it off and move the body part around gently for 5 minutes (hot). Then you can repeat cold to hot treatment as many times as you want. This way you still get pain reduction from the cold sensation, but you get increased blood flow by moving the body part to improve circulation.

So the next time you have an injury, leave the frozen peas in the freezer and focus on gentle movement and loading along with compression to allow for the fastest possible healing time.

But wait, what about cold plunges?

I get asked about these all of the time. And they do have several benefits, depending on how and why you’re using it.

Quick cold plunges can act similarly to the hot-cold pump above, but on a more full-body level. By submerging your body for a few minutes or less, you’ll get vasoconstriction (narrowing) of the blood vessels to conserve body heat, which reduces blood flow to the extremities. This will reduce inflammation and slow swelling. Once you exit the water, vasodilation (widening) of the blood vessels occurs to help flush out waste products and pull new blood flow into the tissues. This cold to hot exchange helps speed up recovery times by speeding up your circulation. 

There are also potential psychological benefits of cold plunges. Cold water has a numbing effect, which affects the central nervous system by reducing pain perception in the brain. It also may act as a form of stress adaptation that teaches the nervous system to respond more efficiently to subsequent stressors. Some proponents believe this mental training can help teach you to cope with discomfort better over time. Physiologically the cold stimulates the release of adrenaline and norepinephrine, which are hormones that prepare the body for “fight or flight”. This leads to an increased level of alertness and a feeling of invigoration. There may also be an increase in endorphins, the body’s natural painkillers, which can contribute to a sense of well-being after a plunge.

Just make sure to keep the plunges short. Prolonged exposure to cold can inhibit the healing process and stunt recovery after exercise or injury, and carries more serious risks of hypothermia, cardiovascular stress, difficulty breathing or panic, and may not be suitable for people with certain health conditions.