Quick, you twisted your ankle, 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. Most people would probably default to that choice.
Not only is R.I.C.E. ineffective, it actually delays your body's natural healing process, making recovery take longer, and can even result in additional tissue damage!
Physiology
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?
How to Heal an Injury
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, or electronic muscle stimulation like Compex, etc. But at the simplest level, you just need to keep those muscles moving!
The emphasis is on pain-free movement and progressive loading of healing tissues. So, particularly if you’re dealing with a severe injury, you should not be fully loading the damaged tissues from the start.
What we want is graded exposure, starting perhaps with contraction without loading. (Such as lying on the couch and just isometrically contracting your calves). From there, adding resistance, and eventually eccentric loading and impact.
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 immobilized to prevent physical deterioration.
(Note that there is more to recovery and progressive loading that is beyond the scope of this post. I recommend seeing a professional about your specific injury.)
If you need to relieve pain, use Tylenol in the correct dosage, and avoid NSAID's, as they also delay healing in a similar mechanism. Just don't use the pain relief to mask exercises that are too-intense for where you're at in the healing process!
Summary
It’s becoming more widely known that early mobilization and loading of healing tissues is key to recovery. Hip and knee replacements often see the patient moving around the very same day.
And guess what? This isn’t something about which the research is inconclusive. Dr. Mirkin, the author of the book that popularized the RICE method, has publicly recanted based on the abundance of evidence that the method is ineffective and counterproductive.
You can read a great summary of the research in this review by Scialoia, et al.
So please, eat your rice, don’t use it to treat an injury.
(Note that I am not a doctor, and that this article is a summary of research on the topic, not original thought.)
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