To RICE or not to RICE

Written by Dr. Meagan Robichaud, PT, DPT

For as long as most of us can remember, the quick answer and solution to an acute soft tissue injury was a no brainer. You’re probably already thinking in your head that the answer is RICE (rest, ice, compress, and elevate). But, what you probably didn’t know is that the current research in sports medicine and acute rehabilitation of injury has a lot of controversy around the topic of icing. So the question is, when to RICE and when to not RICE?

History of RICE

1978: The earliest documentation of RICE as part of the acute injury management guideline proposed by Dr. Mirkin et. al.

1992: RICE became PRICE (protect, rest, ice, compress, and elevate)

2006: PRICE became POLICE (protection, optimal loading, ice, compress, and elevate)

2019: Ice gets removed from the guideline this year and the acronym becomes PEACE & LOVE (protection, elevation, avoid anti-inflammatory drugs, compression, and education & load, optimism, vascularization, and exercise)

The Good and the Ugly of Ice

So why is there so much controversy on whether to ice? Ice treatment can delay the healing process of an acute soft tissue injury due to suppression of inflammation. But, inflammation is actually an essential part of the healing process. When we become injured, our body sends signals to our inflammatory cells which begin the healing process by killing the damaged cells in the area of injury. Ice application acts as a vasoconstrictor which blocks the transport of these inflammatory cells to the injured area, therefore delaying the healing process and reducing blood flow. More often than not, swelling is always seen as “bad” and the stigma is to get rid of all swelling as quickly as possible. But, as we now know, this is actually the opposite of what we want to do in most cases.

Although we have spent some time talking about the negatives to ice therapy, there are still situations in which it can be considered. Ice therapy continues to have validity in pain reduction due to its numbing qualities. But, we have to weigh the benefit of pain reduction over delaying healing and lengthening the recovery process in an individual. Is it really worth it in the long run? Ice can also be used in situations where there is severe inflammation such as post operatively or in severe joint sprains where we want to control edema. Too much inflammation in these cases can actually limit mobility and therefore impede progress in recovery from an acute soft tissue injury.

Ice vs. Heat

When a patient comes into the clinic and asks me “should I ice or heat my injury?” My answer 90% of the time is to heat the injury. (The other 10% is to ice in the situations we talked about above). Heat therapy such as hot packs or submerging the injured area in warm water has more validity in the healing process as heat tends to promote blood flow to the area and stimulate the inflammatory response, therefore speeding up the recovery process. Heat can also improve joint range of motion and muscle flexibility which can increase overall mobility and aid in the rehabilitation process.

Conclusions:

Clearly, there is more research that needs to be done on this subject to give anyone a clear answer on what the correct plan of action is when it comes to cold therapy. But, I think it is safe to say that in most cases we should put the RICE term to bed and focus our efforts on early movement and heat therapy in an acute soft tissue injury in order to promote blood flow and encourage faster healing of the tissues. “Motion is Lotion” as we say, after all!! As a review, cold therapy like ice packs and cryotherapy treatments can be used in situations where our body has an extreme inflammatory response to an injury such as post operatively where inflammation is inhibiting recovery. In other words, we are not saying that we should all throw our ice packs and bags of frozen peas in the garbage just yet. But instead, we hope that everyone's eyes will be open to this new way of thinking and treating an acute injury with the guidelines in the latest research.

If you are dealing with an injury and have questions on how you should be managing it, please reach out to our professionals at Magna Physical Therapy. We are happy to help answer your questions and get you back on your feet as quickly as possible!

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173427/