Written by Dr. Devyn Christian
Have you heard of the acronym RICE before? Rest, Ice, Compression, and Elevation is what many of us were taught to do immediately after an injury. Every bump, bruise, and sprain I’ve ever had has been slapped with a bag of ice as long as I can remember. Dr. Gabe Mirkin was responsible for coining the phrase RICE over thirty years ago and has since admitted that he was wrong.
“Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.” – Gabe Mirkin, MD, March 2014
When looking at the basic physiology of what occurs during an acute injury, there are three distinctive phases; inflammatory, proliferative, and the remodeling phase. When we apply ice to an injury, we are actually slowing down the natural inflammatory process of the body, rather than letting the body do what it does best. Our bodies are incredibly efficient machines! A great example of this is when our body is in starvation, it will spare absolutely everything before having to break down the most essential organs for survival. So is it possible that the cardinal signs of inflammation; the swelling, the heat, the redness, are all just the body telling us it is aware of the injury and is gathering all the troops necessary for repair.
One of the primary arguments you often see is that “ice decreases swelling”. This has actually been proven to be the opposite. Our body’s natural waste removal system is called the lymphatic system. It has no pumps like our arteries do and so it requires the contraction of skeletal muscle to keep the fluid moving through the pipes. When ice is applied to an injury site the lymphatic system increases its permeability so that more fluid leaks into the area and gets trapped causing swelling.
Another common belief is that ice helps tissue heal faster, and if you’ve sensed the theme of this article, of course this isn’t the case either. When an injury occurs inflammatory cells are summoned to the area to help out. Inflammatory cells are designed to release a hormone known as Insulin-like Growth Factor (IGF-1). IGF-1 helps to stimulate new tissue growth and proliferation of new cells. The application of ice inhibits the release of IGF-1 as well as constricts blood vessels going to the injured area, thereby slowing down the body’s innate repair system.
The claim that icing sore muscles helps with recovery and athletic performance has also been proven to be false. I remember back in my track days, I’d follow every practice with an ice bath to help my legs “recover”. Research actually shows that icing slows nerve firing and interferes with the strength, speed, and coordination of muscle. Studies conducted on the effects of cooling muscles reported that immediately after icing there was a decrease in strength, speed, power and agility-based running. Here is a quote from a paper published in 2013 in the Journal of Strength & Conditioning Research:
“This data suggests that topical cooling, a commonly used clinical intervention, seems to not improve but rather delays recovery from eccentric exercise-induced muscle damage”
So the question is if icing does not reduce swelling, it does not help tissue repair, and it does not reduce soreness and help with recovery, why is it still so commonly used by medical professionals? The research is out there but the reason that many have not yet ditched icing for good is because ice does have some pain relieving properties. Ice does temporarily relieve pain through gate control theory but the effects are short lasting, 20-30 minutes on average. And even though it may help with the pain, it has a detrimental effect on the actual healing of the injured tissue.
If you can’t ice, then what are the best things you can do for an injury to heal as quickly as possible? Keep it moving! Anything you can do to keep fluids pumping in and out of the area without causing excessive pain is helpful. Slow passive motion, gentle traction, alternating tensing and relaxing the area of injury, using electrical muscle stimulation, and massage are all ways to help the lymphatic system step up a notch so it is best able to do its job of ridding the area of waste to make room for repair cells to do their best work!