Updated: Nov 2, 2020
Quick, you twisted your ankle hard, and it’s swelling up. What do you do?
A. “Walk it off.”
B. R.I.C.E. it.
Probably the most widely-known protocol in western medicine, RICE stands for rest, ice, compression, and elevation. Many people would probably answer B.
But does RICE work? Well, no, not really. In fact, it‘s possibly the worst thing you can do for most injuries!
Let’s step back. The human body has an incredible self-repair function. It relies on the blood to carry in nutrients and the lymphatic system to carry out waste. You have 165,000 miles of tubing in your body specifically designed to flush out waste. Yeah, check that number again. More miles than you’ll run in your lifetime!
While the heart actively pumps your blood, the lymphatic system is passive. That means the “pump” in the lymphatic system is the repeated contraction of muscles surrounding the injured area.
By resting, icing, compressing, etc, you’re limiting that drainage. You’re also limiting the flow of blood flow in with nutrients to repair the damage. In a nutshell, icing delays healing, increases swelling and can cause further damage.
So what should you do? Let’s start with what needs to happen in order to have recovery of your damaged tissues.
First, the congestion in the area needs to be flushed out, otherwise you may see further damage, and it will at least lead to pain.
Second, you want to boost blood flow and angiogenesis in the damaged area. This is what will actually enable repair of the damage.
Third, you need to prevent disuse atrophy.
Finally, you need to allow restructuring and reorganization of the tissue as it heals, so that you don’t end up with scar tissue that can’t function as it’s supposed to.
As noted above, icing and static compression hinder all of those processes.
But guess what accomplishes ALL of them?
Active recovery! Moving and contracting the tissues. Quite literally, “walking it off.” I guess those old high school coaches were right after all.
You can also combine muscle contractions with elevation, and potentially also use pneumatic compression, like Normatec. But at it’s simplest, you just need to keep those muscles moving!
Now, if you’re dealing with a severe injury, you probably should not be fully loading the damaged tissues. You’ll need graded exposure, starting perhaps with contraction without loading. (Such as lying on the couch and just isometrically contracting your calves). There are certainly some injuries you need to be cautious with. Some joint injuries will require different techniques such as muscle stimulation, because you have to keep the joint mobilized to prevent physical damage.
However, it’s becoming more widely known that early mobilization and loading is key to recovery. Hip and knee replacements often see the patient moving around the very same day.
(Note that there is more to recovery and graded exposure that is beyond the scope of this post. I recommend seeing a professional, or at the very least researching your specific injury.)
And guess what? This isn’t something about which the research is inconclusive. The man who invented the RICE protocol has even publicly retracted it.
So please, eat your rice, don’t use it to treat an injury.
(Note that I am not a doctor, and that this training tip is a summary of research on the topic, not original thought.)
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