The R.I.C.E. protocol (Rest, Ice Compression, Elevation) for injury management is outdated
Dr Mirkin developed this protocol in 1978, and he said in 2014 that there has been more recent research that shows both ice and complete rest may delay healing instead of helping. And that compression and elevation has it's place if done correctly. Let us explain these claims further.
I wanted to share an experience I had playing basketball recently. I was feeling physically really good, no recent injuries or issues. I was playing well until the 2nd half, I unfortunately rolled my ankle when trying to change direction suddenly and caused an ankle sprain. It bloody hurt and I struggled to weigh bear and walk after. Thankfully it wasn't worse and I fully recovered 4 weeks post injury. However, what was interesting was that when I got up and hopped over to the bench, the centre supervisor rushed to get me an ice pack. I've seen this time and time again as a spectator and a player. I then surprised the supervisor with my response when I kindly declined the ice pack and said that I'd tighten my shoes to compress the area instead.
You may ask why I didn't accept the ice pack?
Doesn't ice help you heal the injury faster?
Stop the swelling?
Why would I do this?
Here's why...
Dr Mirkin developed the R.I.C.E. protocol for when recovering from an injury usually soft tissues and broken bone injuries. This protocol was published in one of Dr Mirkin's book in 1978, that was more than 50 years ago. In 2014, that same Doctor said that there has been more research since the release of his book 50 years ago, that shows both applying ice to the injured area and complete rest may delay healing instead of helping.
Why does applying ice delay healing?
Healing requires inflammation. When you injure body tissue such as ligaments, muscles or bones, your body's immune system kicks in to heal that area as soon as possible by sending inflammatory cells to start the healing and repair process. The inflammatory cells release a hormone called Insulin-like-growth factor (IGF-1) into the damaged tissues, which helps the injured tissue to heal. Appling ice to the injured area to reduce swelling actually delays healing by preventing the body from releasing these healing hormones.
So why didn't I apply ice directly after getting inured and any time post injury? Ice keeps healing cells from entering injured tissue! Applying ice to injured tissue causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation. The blood vessels do not open again for many hours after the ice is applied. This decreased blood flow can slow the healing process down significantly.
Now I'm not saying not to use ice all the time. If you are in extreme pain, ice helps number the injured area for some pain relief. However, what I am saying is that ice should not be a long term injury management strategy. It does not help the healing process.
What about complete rest post injury?
Rest in the R.I.C.E. protocol has also advanced. What I mean by this is that researchers actually recommend 'active' rest instead.
What do I mean by active rest? Well even though my ankle hurt when walking, it is common sense to avoid doing things that are painful post injury, eg: walking with full pressure on the foot, running, jumping etc.
But it doesn't mean I have to be in bed or on the couch with my leg elevated all day every day for the next 3-4 weeks. I can still move every other part of the body. And I can also still move my ankle. I can do ankle circles and some low resisted calf raises to keep movement through the ankle so it does not stiffen up. Another great thing about staying active is that when moving or exercising the blood flow around the body and to the injured area increases. This means that the healing process is being enhanced with more blood going through to the area that needs it.
Which is where strength training can be so versatile as a form of exercise as there are so many exercises I can do that will move blood around my body, maintain strength and get all the added benefits for my health.
Now I've been here before and experienced sprain ankles before, so I have a rough idea and indication on the rehab process. However, injury symptoms post injury can change, and the exact diagnosis can be hard to tell. So, if anyone experiences anything similar please do reach out to a physio, osteo or GP. Everyone's circumstances are different, and it would be recommended getting guidance from a qualified professional that works with injuries. Ask then what you can do to keep active and enhance your healing. And when you have set parameters or constraints, work with that when going through the recovery process.
In conclusion, if you get injured...put the ice back in the freezer and move the body and inured area if possible. This will promote more blood flow to the injured area and enhance the healing process. Compression and elevation of the foot does help. But don't have the compression too tight. And don't spend long hours sitting down. Obviously avoid any movement that causes pain or unnecessary stress or strain in that injured area.
I hope this was helpful and insightful and that you can apply this updated knowledge when managing your injuries.
If you need any assistance with rehab and getting back to optimal performance and movement, please reach out to us. We can either help or point you in the right direction.
Nathan Palenkas
Strength Coach
Inner Athlete AUS
