Is Rest, Ice, Compression and Elevation the best for injury recovery?

Back in the late 70’s, Dr Gabe Mirkin introduced the term RICE (rest, ice, compression and elevation) which has become the mantra for all athletes and therapists alike, but is the use of ice now becoming a thing of the past? A series of studies that show that injury treatment with ice and total rest may actually delay healing even has Dr Mirkin shifting his way of thinking.

This new line of thinking is proving controversial and has caused extensive debate as RICE has been the first line treatment option for decades. Ice helps relieve pain and swelling and reduce inflammation. However, inflammation is the body’s first physical response to repairing tissue, and without it healing will slow down.

One study published in The Journal of Strength and Conditioning Research had a look at the influence of icing on muscle damage. Data from the study did show that icing delays recovery and should not be the first choice of treatment for injuries. After icing there was an immediate increase in swelling. Indicators of muscle damage increased after application of ice.

Other research published has similar supporting arguments: The American Journal of Sports Medicine in June 2013, said that although icing an injury relieved swelling it did not make recovery from muscle damage quicker. If the treatment reduces inflammation it delays healing. This includes the use of anti-inflammatory pain relievers like ibuprofen.

Inflammatory cells called macrophages release hormones into the damaged tissues that help them heal. If you then apply ice to the damaged area you will reduce swelling which prevents the body from releasing this hormone and delaying healing.

This was shown in a Cleveland Clinic study published in the Federation of American Societies for Experimental Biology in November 2010. The body will naturally remove any swelling through the lymphatic system once the healing process is done.

Mirkin, who wrote the Sports Medicine Book in the late 70’s that introduced RICE, said in 2014 that an injured person should stop exercising (although not resort to complete inactivity), since total rest also does not stimulate tissue repair. Complete rest causes tissue to waste, so he recommends using light exercise as a repair stimulus.

Mirkin says it is okay to apply ice for pain relief immediately after the injury occurs, but for short periods only. He suggests icing for 10 minutes, removing the ice for 20 minutes, and repeating the process once or twice, but stresses that there is no reason to continue icing more than six hours after injury. A new acronym, MCE, replaces the old standard RICE, and leaves out cold therapy for injury treatment. MCE stands for Move safely when you can as much as you can, Compress, and Elevate.

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