RICE Method: Doesn’t Work The Way You Want It To

You’ve likely heard of the RICE method. It’s a regimen of Rest, Ice, Compression and Elevation in the process of healing an injury. Even though it’s deeply ingrained in our culture, we should no longer follow these outdated (and flat out incorrect) guidelines!

As an active kid and teen I grew up with numerous sporting injuries, and was told on just as many occasions to ice and rest it in order to reduce/prevent the inflammation and encourage healing. It’s funny and unfortunate that we don’t typically question the things that have been told to us from such a young age. It doesn’t help that this information comes from health care professionals who we trust to know what they’re speaking about.

What’s Wrong With Icing?

The old guidelines are working to oppose the natural healing process of the body. If it is one thing that I’ve come across in my studies of the human body, it’s that “the body knows best”. If we look at the process of healing in the body it doesn’t make any logical sense that we’d try to oppose it. The body is indeed the perfect pharmacy (in the vast majority of situations), and responds appropriately and with just the right amount of inflammation when needed.

So What Should We do?

Interestingly enough two of the new recommendations for healing soft tissue injuries are “movement” and “treatments”. Keeping the body moving [mindfully and not painfully] within the first 72 hrs aids in naturally regulating the levels of inflammation. Muscle action helps to “pump” some of the inflammation away from the injury site, ensuring that excess does not accumulate. Let’s look at why these have become the most current recommendations:

It’s really all about the blood.

Movement promotes blood flow to an injured area. Blood brings Oxygen, nutrients and healing cells to nourish the surviving tissue, remove cellular debris and provide the necessary building blocks for regeneration and repair. Within the first 72hrs after the injury movement should be mindful and through pain-free ranges of motion.

After the first 72hrs massage techniques can assist in bringing greater blood flow to specific regions of the body. Appropriately used, massage techniques also enhance the dissolution of “knots” or build-up of soft tissue and help to align the newly forming tissues correctly. We can also manipulate the body into stretches that explore a pain-free range of motion, helping to ensure that tissues stay well lubricated and mobile and that any stiffness is reduced. [Additional note] Please do not attempt this without the appropriate training and level of knowledge – this statement is merely noting an example of what is possible when massage is used appropriately, it is not giving you permission to use it without training.

The RICE method is designed to inhibit the natural process of the body bringing greater volumes of blood to an injured site. The reason the body has a process of inflammation is to bring greater blood supply, more oxygen and larger numbers of healing cells to the area and to clear out all the things it no longer needs there. Ultimately, icing a soft tissue injury (even in the acute phase) actually slows the healing process and can even lead to incomplete healing of soft tissue damage!

Backed By Science

This is not only our perspective, but the perspective of the very person who developed the RICE method (Gabe Mirkin) in 1978. Read Dr. Mirkin’s statement of retraction/correction here. His main statements are summarized as follows:

• Healing requires inflammation
• Icing prevents healing cells from entering injured tissue
• Reducing inflammation delays healing
• Ice also reduces strength, speed, endurance and coordination
• Cooling techniques may be required in certain circumstances as it has been shown to reduce the sensation of pain (note this still delays healing).

To once again be clear, this is relevant to the vast majority of soft tissue injuries. There are a few instances in severe trauma to the body where ice is necessary to curb excessive inflammation that might otherwise cause systemic problems. For the rest of us, icing is only useful for numbing the pain.

Beyond the first 72hrs, Thai massage can significantly improve the healing experience and reduce the overall time it takes to regain full function of soft tissue after an injury. Of course, we need to study and understand the process of inflammation to ensure that our work doesn’t promote excess inflammation.

P.S. Please also note that the Do No HARM protocol is still relevant (no Heat, Alcohol, Running or Massage) within the first 72hr period.

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For further reading on inlfammation, check this out: “Inflammation. Only Occasionally The Bad Guy You Think It Is.“. If you want you mind similarly blown by another article, read this: “Yes, Your IT-Band Is Tight…But It Should Be.“.