Rest, Ice, Compression, Elevation (RICE)
In 1978 Dr Gabe Mirkin used the acronym R.I.C.E (rest, ice, compression, elevation) to describe what was considered to be the most effective method for treating soft tissue sports injuries such as sprains and strains. The method has been relied upon for several decades, with ice being the preferred treatment from school sports to international athletics. The first instinct of myriad coaches and parents is to immediately apply an ice pack to the area of injury, following the idea that ice restricts blood flow to the area and therefore numbs pain and keeps initial swelling from increasing in injured tissue. However, new research suggests this may not be the case.
Several recent studies looking at the impact of cold therapy on injuries have shown little to no effect on healing. In a study published in the Journal of Sports Science and Medicine, the effectiveness of cold water immersion treatment was found to be insignificant in restoring muscle function after an 80-minute rugby game (Takeda et al., 2014). Another paper examining whole-body cryotherapy (WBC) found that although exposure to air temperatures below -100 degrees Celsius was believed to enhance recovery after exercise, there was only weak evidence from controlled studies showing that WBC is effective on inflammation or functional recovery (Bleakley et al., 2014). Additionally, a study by Rubley, Denegar, Buckley and Newall (2003) had concluded that cryotherapy could actually reduce muscle strength, nerve conduction, velocity, and proprioception; all important functions in athletics.
There is a similar difficulty with the belief that rest contributes to a speedier recovery. It was previously assumed that recovery required rest. However, there has been a reversal of opinion in recent years, with recent suggestions that complete inactivity does nothing to stimulate tissue repair, and can instead lead to tissue waste. This year, Dr Mirkin described how light exercise is far more beneficial as a repair stimulus, stating the need for athletes to allow inflammation as part of the healing process.
Swelling Aids Recovery
The immune system is designed to heal tissue injury through the same biological mechanisms that it employs to remove germs from the body. The same inflammatory cells and proteins (macrophages) that the body sends to attack pathogens are also directed to damaged tissue to promote healing when an individual is injured. These macrophages release a hormone called Insulin-like growth Factor (IGF-1), which encourages the damaged tissue to repair itself. Applying ice to the area stops the body releasing this hormone and therefore delays the healing process. Anything that slows or restricts the blood flow will have a damaging effect on the body’s ability to recover. This includes most pain-relieving or anti-inflammatory medicines such as Ibuprofen, cortisone-type drugs, immunosuppressants, and the application of cold therapy such as ice packs or cold water immersion. In fact, studies have shown that this decreased blood flow can cause tissue to die and even cause permanent nerve damage at worst.
Movement, Elevation, Traction, Heat
Since early work into the effects of cold treatment on the depression of the body’s physiological systems, there has been concern about its impact on motor injury among many healthcare practitioners. A more in-depth understanding of both the immediate and delayed effects on recovery and functional performance is therefore needed. However, Dr Mirkin’s revised recommendations on injury treatment suggest only applying ice for pain reduction and then only for short periods soon after the injury occurs. Mirkin advises not to apply ice more than six hours after injury, and states that for minor injuries an individual can begin rehabilitation the next day as long as movement does not increase the pain. This guidance is shared by others in the sports and physiology world, who advise that the worst thing anyone can do with such an injury is to stop all movement.
Instead, it is argued, a better treatment method would be the use of M.E.T.H (movement, elevation, traction, heat). Continued movement and traction helps to speed up the removal of waste chemicals through the lymphatic system and increases blood flow to allow macrophages to travel to the injured area. Elevating the damaged limb is thought to work in a similar way, moving blood from the injured area towards the heart and lungs, and assisting in flushing out swelling and inflammation once it has done its job. Movement also prevents stiffness and pain. Heat can be used in some cases to stimulate blood flow, and relax tight muscles. However, moist heat is considered better than applying dry heat on injuries, as the moisture acts as a conductor directly between the heat pack and the skin and results in greater penetration. Dry heat can be less effective, due to the delayed transfer of heat to the body, and can in fact be detrimental to recovery in some cases due to the dehydrating effect on the skin.
It is clear that further research is needed on the varying effects of temperature therapy on the body. The above findings do suggest that the use of heat or cold therapy may offer only negligible improvements, and in certain cases have a negative impact. It may be that the best course of action is therefore to listen to your body, allow it to heal itself, and return to normal activity as soon as you feel able to do so.
- Bleakley, C.M., Bieuzen, F., Davison, G.W., Costello, J.T. (2014) Whole-body cryotherapy: empirical evidence and theoretical perspectives. Open Access Journal of Sports Medicine, (5)25:36. Available at: https://www.dovepress.com/whole-body-cryotherapy-empirical-evidence-and-theoretical-perspectives-a16060 [Accessed 18th November 2014].
- Mirkin, G. (2014) Why Ice Delays Recovery. Available at: https://drmirkin.com/fitness/why-ice-delays-recovery.html [Accessed 18th November 2014].
- Petrofsky, J., Bark, L., Bains, G., Khowailed, I.A., Hui, T., Granado, M., Laymon, M., Lee, H. (2013) Moist Heat or Dry Heat for Delayed Onset Muscle Soreness. Journal of Clinical Medicine Research, 5(6)416:425. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808259/ [Accessed 18th November 2014].
- Rubley, M.D., Denegar, C.R., Buckley, W.E., Newell, K.M. (2003) Cryotherapy, Sensation and Isometric-Force Variability. Journal of Athletic Training, 38(2)113:119. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164899/ [Accessed 18th November 2014].
- Takeda, M., Takashi, S., Tatsushi, H., Hiroto, S., Hisashi, K., Yoshihiko, Y & Zsolt, R. (2014) The Effects of Cold Water Immersion after Rugby Training on Muscle Power and Biochemical Markers. Journal of Sports Science and Medicine, (13)616:623. Available at: https://www.jssm.org/hfabst.php?id=jssm-13-616.xml [Accessed 17th November 2014].
Photo: Steven Depolo