Saturday 16 May 2020

Should you RICE RICE baby?

Picture from

A staple of injury healing, the RICE methodology has been around since Sportsmedicine Book was released in 1978. It is an acronym for Rest Ice Compress and Elevate and is the go to response when someone suffers an injury.

We've all either used it ourselves or been told by a doctor or physio to. Yet over the years it has come under ever more scrutiny with even the doctor who first came up with the RICE method, Dr. Gabe Mirkin, decades later changing his view on the Rest and Ice parts of it as they can actually delay your recovery.

Table of contents

Movement over rest

Resting your injury makes a lot of sense. With more rest then it will heal better, right? Well, depending on the type of injury and your stage of recovery no it turns out.

If the injury is not a fracture, spinal or a catastrophic injury, then movement is necessary in the recovery process. In fact too much rest can be detrimental.

In 1996, doctors Jim and Phil Wharton released The Wharton's Stretch Book, which argued that movement rather than rest should be performed on an injury. The key reasons being that:

  • Rest causes the muscle to be inactive, thus shutting down and restricting blood flow.
  • Immobilisation of a muscle caused it and everything around it such as tendons and ligaments to atrophy (get smaller).
  • Muscular-imbalances due to compensations the body needs to make to get around an injured atrophied area.
  • That movement at a muscle or joint encouraged "blood flow to oxygenate the area and flush out metabolic waste from the injury".
  • Any careful and gentle movement no matter how small was good for helping improve range of motion after an injury.
Restricting movement could lead to delayed recovery. Picture from Industrial Health & Hygiene News

On the reverse side however too much movement, such as continuing on as normal or trying too much too soon, can exacerbate the injury and increase inflammation. This itself can lead to the injury being stuck in a chronic inflammation phase preventing recovery resulting in tissue atrophy etc. If it hurts or feels strenuous then you're doing too much too soon.

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Warmth over ice

The Wharton's despite their recommendation to substitute movement for rest, still agreed with icing the injured area. Other's however have come out against this part of the RICE protocol including its inventor.

On Dr. Mirkin's website is his article Why Ice Delays Recovery, first published in 2015. A highlight of the key points include:

  • Ice treatment causes blood vessels to constrict and close. These took many hours to reopen deceasing blood flow.
  • This could cause nerve damage and even tissue death.
  • Ice and cold packs reduced inflammation, which also delays healing.
  • Icing for more than 5 minutes reduces a person's strength, speed, endurance and coordination.

According to Muscle Injuries: Biology and Treatment, published in American Journal of Sports Medicine (vol. 33, no. 5, pp. 745-764, 2005), no randomised clinical trials have proven the effectiveness of icing an injury to aid recovery. This was backed up by a meta-analysis in the British Journal of Sports Medicine of 22 separate studies on the effects of ice on acute muscle strains.

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Alternative to RICE?

There is one alternative to RICE that seems to be gaining traction - MEAT. This acronym stands for:

  • Movement - Gentle movement to help encourage blood flow, improve range of motion, as well to ensure scar tissue forms in proper alignment. Helps prevent atrophy.
  • Exercise - Controlled and specifically prescribed to progressively improve range of motion and strength.
  • Analgesics - For pain relief, however not NSAIDs. Natural pain relief has been suggested as more beneficial.
  • Treatment - A long term solution, such as physiotherapy, to aid in successfully recovering from the injury.
RIC or MEAT injury recovery protocol
Would you like a side of meat or rice with your injury, sir?

Of course this applies to non-acute injuries. The RICE protocol still has merit when it comes to helping reduce swelling and pain in serious injuries such as fractures, torn ligaments etc. though once the injury has settled MEAT comes into play.

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If the injury is not a serious one then resting it can be detrimental to the injured area and prolong your recovery. It can lead to atrophy of the affected area and a loss of strength as well as imbalances.

In regards to icing, it is good for pain relief and reducing inflammation, especially in the immediate aftermath of an injury, however it also delays the recovery process and can actually cause tissue death and nerve damage.

MEAT on the other hand helps encourage the healing process whilst maintaining tissue health, yet RICE does have its place for helping with acute injuries. Thus after four decades RICE would seem to have had its day in certain aspects with MEAT appearing to be the way to go... unless of course you're a vegetarian or vegan.

Lyle Richardson,
Gym Pal - Your Friend In Fitness


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