Introduction

If you've ever experienced a soft tissue injury, such as a sprain, strain, or a pull; you have probably been advised to follow the R.I.C.E. protocol. Or at least, the "I" component of that, which stands for Ice, i.e. to put ice on the affected areas as soon as possible and at regular times for days following the injury.

However, more recent research suggests that this can delay recovery, and in more extreme cases, actually make things worse!  Continue reading below to find out why and what to do instead.

For those who would prefer to watch a video instead, please check out the video below, otherwise read on for the remainder of this week's blog article.

Summary

• R.I.C.E. = Rest, Ice, Compression, and Elevation
• It's a protocol for treating soft tissue injuries that is now over 4 decades old and is not supported by current research
• In fact, Ice and Rest can actually delay the healing process
• Better protocols are available and my preferred approach is covered in this article

Watch The Video

(Or scroll down to read the article below the video)

Read The Article

The R.I.C.E. protocol was developed back in the 1970s by Dr Gabe Mirkin, who coined the phrase in his best-selling book, Sportsmedicine (published in 1978).

R.I.C.E. is an acronym for Rest, Ice, Compression, and Elevation. It refers to the 4 steps suggested as the most effective treatment for soft tissue injuries.

This treatment approach has become the preferred method for over 4 decades, with the vast majority of people experiencing a soft tissue injury, myself included in the past, opting to either self-treat with Ice or being advised to by a medical professional.

One of the reasons that the Ice approach in particular has become so popular is the initial analgesic (pain-relieving) effect it has on the injured area - i.e. it helps to reduce the initial pain experienced moments after the injury occurs. But, prolonged or continuous Ice use can slow down the healing process and potentially cause tissue damage.

In 2015, Dr Mirkin published an article[1] where he actually rescinds his own advice of using the R.I.C.E. protocol (based on new evidence-based research). In that article, Dr Mirkin says:

"Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping"

Why is this?

When an injury occurs, the body responds by sending inflammatory cells, called macrophages, to the damaged area to start the healing process. These cells release a hormone called Insulin-like growth Factor (IGF-1) into the damaged tissues, which helps them to heal. Ice, however, delays the healing process by preventing the cells from releasing IGF-1.

Ice also causes the blood vessels in the applied area to constrict, which reduces blood flow to the area. The reduced blood flow stops the healing cells from reaching the affected area, and in the worst cases can actually result in tissue death and nerve damage.

All of this is part of the natural inflammatory response to damage in your body, so anything that reduces your normal inflammatory response will have a similar effect in delaying the healing process. This includes another common "treatment method", the use of anti-inflammatory medication (NSAIDs) such as Ibuprofen, Naproxen, Diclofenac, etc.

I've talked a lot so far about the I part of the R.I.C.E. protocol, but what about the other parts?

Well, Rest can also delay the healing process.

Your body manages the clearing away of fluid build-up in the damaged area by utilising your lymphatic system. The lymphatic system though is reliant on your skeletal muscles providing a propulsive force to move lymph through active muscle contraction. Complete rest stops this and shuts down the lymphatic system.

As for Compression and Elevation, there is little evidence that supports the benefits in terms of soft tissue injury rehabilitation. It is worth noting though, that equally there is no research that suggests it has any negative effect either.

So if R.I.C.E. isn't the best approach, what is?

Short answer... Let your body do what it does best.

A slightly longer answer (because things are never that straightforward)...
In terms of Rest, you don't want to stop moving your body, for the reasons mentioned earlier, but you also don't want to cause any further damage to the affected area. So, keep moving as much as possible without causing pain.

Lightly move the affected area through a small range of motion that doesn't cause pain, and do this regularly whilst slowly increasing the range to motion, but always ensuring your don't cause further damage.

Applying Ice to a soft tissue injury immediately can help with reducing pain, so if pain relief is what you're looking for then go ahead and apply Ice, but only briefly for about 5-10 minutes with a break of about 20 minutes before reapplying for a total of once or twice maximum. The exception is when there is a complete ligament tear such as the anterior and posterior cruciate ligaments in the knee, that will require surgery. The application of ice in these cases can decrease the flexibility of the ligaments.

Compression can be a useful support (excuse the pun) to provide some stability around the affected area that allows you to keep moving, and the research shows no adverse effects. So use compression if you feel it helps but most importantly ensure you are moving the affected area as soon as possible, whilst slowly increasing the range of (pain-free) motion.

Elevation can help immediately to reduce swelling in the affected area but again, the research doesn't support it as a positive or necessary step to encourage healing. Similarly, the research doesn't show any adverse effects for people who do want to use Elevation in their rehabilitation.

There have been various alternative protocols to R.I.C.E. proposed, but my preferred approach is known as "MEAT" as it covers all aspects of the recovery process that I typically follow for my own injuries. This approach includes:

• (M)ovement: Move the damaged area through a range of motion that is pain-free so that you can adequately move lymph throughout the body to aid the healing process
• (E)xercise: Beyond the initial basic movement, resistance-based exercise should be the next step, especially focusing on eccentric loading
• (A)nalgesia: Pain will impact your ability to adequately move the affected area, so using pain relief that doesn't disrupt the body's natural inflammatory process can aid in rehabilitation (avoid anti-inflammatory pain relief such as Ibuprofen)
• (T)reatment: The final part of the protocol is to find the best therapeutic treatment approach(es) to help with your rehabilitation, these can include (but are not limited to) sports massage, acupuncture, and taping. Treatment can also include supplementation that naturally helps your body with the healing process

Over to you... What's been your experience of recovering from a soft tissue injury? Have you always been told to follow the R.I.C.E. protocol?

What do you think of the MEAT alternative, and which protocol will you follow next time you experience a soft tissue injury? Drop a comment down below to share your thoughts and experiences.

Also, if you know of anyone currently recovering from a soft tissue injury, please share this article with them to help them see that the latest research shows that R.I.C.E. is not actually the best solution to get them back to full health as quickly as possible.

I hope you found this useful, I've certainly enjoyed creating it and I hope it helps to improve your recovery from any future injuries so that you can get back to running as soon as possible.

Happy running, stay safe and bye for now.

Barrie
BE Fit Coach

Related Posts

6 Great Reasons You Shouldn’t Skip Easy Runs

Runners, how do you push your body when your mind says "NO!"?

Are You Self-Sabotaging Your Running?

5 Signs Lack Of Sleep Could Be Sabotaging Your Running

7 Core Pillars of Running - Hint: It's Not Just About Getting The Miles In!

Full Transcript

[The following is the full transcript of this episode of the BE Fit Coach "Let's Talk Running" show.  Please note that this episode, like all LTR episodes, is often unscripted and unedited and features Barrie talking about a subject that we believe runners will find useful and interesting.]

This video has not yet been transcribed.  Once the transcription is available it will be updated here.

How can BE Fit Coach help you?

We have a range of services that can ensure you are training optimally for you! We are all individuals, with unique and sometimes challenging lives, so choose a training solution that works with you, for you.

At BE Fit Coach, we are constantly working on developing new programs and courses. If you'd like to ensure you are kept up-to-date then I recommend joining our email list (below) as that is where all new announcements are made first!