No RICE for you!

Over the last few years, many physical therapists, physicians and fitness professionals have been shifting their perspective on using ice to treat certain injuries. The ubiquitous use of rest, ice, compress and elevate or RICE has been the treatment for sprains, tears, muscle pulls and soft tissue injuries for a very long time.

Known as cryotherapy, icing has been a by the book essential treatment for managing a vast assortment of physical fitness injuries. It has been the single most common go-to treatment practice due to icing’s low or no cost and no drugs required approach. Icing gave nearly immediate results in pain reduction and seemed to manage swelling very well. A quick 15-minute application of ice, then compression along with elevation while resting, then repeat is safe and easily understood.

I am betting that most of you still use icing as your primary treatment for workout or sport injuries. Some of you have likely been seeing a lot of new trending information coming out that is putting the practice of icing into question. Let’s take a look at what we know and don’t know about icing as a treatment for injuries.

Debunking cryotherapy or icing as a bad thing or incorrect practice is not necessarily the point here. Icing under certain conditions as a short-term way to immediately address pain or trauma for an injury may well be smart and needed. The aspect that needs to be understood is around less severe injuries and why our bodies react to an injury with inflammation.

The process of inflammation is the body’s way to quickly protect the injured area. Inflammation is a natural healing process that traps toxins, immobilizes or restricts movement and increases blood flow to the injury. This swelling and associated pain is your body’s first responders telling you to minimize using the injured area and to help force blood flow to activate the healing process. This is a very basic description of what is a fairly complexed series of processes that involves your circulatory system, lymphatic system and tissue repair mechanisms.

When ice is applied to an injury, the very first thing it does is counter the body’s inflammation response and you may think that is a very good thing. The reduction in inflammation to your injured area does a couple of things that are problematic. First the reduced swelling and pain reduction can give you a false sense that you’re good to go and start over using the effected area before real healing has had a chance to take place. Secondly icing slows or stops vasodilation caused by the inflammation which means you are restricting blood flow to the injury. Blood flow to the injury is a needed aspect for your body to remove waste products and give your injury adequate blood supply to promote healing.

The other interesting piece to the implication that icing may not be a best practice is how it effects the lymphatic response. When ice is applied to an injury, it not only restricts blood flow but it also restricts lymphatic flow and research has found this restriction can promote fluid buildup. Your circulatory system must assist the lymphatic system to clear toxins and provoke an immune response for healing. Ice seems to create a back flow affect that allows fluid build up instead of consistent fluid removal.

So back to my assessment that icing is appropriate under certain conditions. I think first responders, physical therapists and physicians would all agree that quick icing is definitely the proper action to take for acute injuries like an ankle sprain. It all comes down to timing. Short term immediate icing can be a great assist while you seek medical care or get yourself stabilized and comfortable. Once you understand the level of injury or strain, then delaying or stopping icing for a few days has shown to actually speed up recovery time within the first 36 to 48 hours following the injury.

Your best bet for minor aches and pains is to let your body’s natural healing process get the job done. There are a number of health care and fitness professionals that have moved from RICE to ECM or elevate, compress and move as a recommended course of treating minor sports or fitness related injuries. Please note that the move portion of this approach is minor, low impact movements that helps the area with blood flow and stiffness. Basic safe movement can help the immune system circulate leukocytes and macrophages which are white blood cells used by the body for healing.

I think it is fair to say that not all health care or fitness professionals will agree to limiting ice for your injuries. I do believe there has been enough compelling research and the fact that we humans evolved to heal without ice, to make a solid case to limit icing injures over an extended time. Perhaps give this a try the next time you have a minor sprain or tear, either avoid using ice or just use ice for an immediate action, then stop once you are stabilized and see how you heal.

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Judd Jones is a director for The Hagadone Corporation in Coeur d’Alene.