And why RICE is bullshit
Ok, ok I know I love a good ice bath. So why am I telling you to stop them then? Hear me out; ice has been used for decades as a protocol for most injuries from: treat minor abrasions and contusions to post surgery recovery.
I’m here to tell you to stop and I have the science to back me up.
Why we use ice in the first place
In the 1940’s surgeons found that using ice dramatically increased the success of their surgeries, especially amputations. This has then trickled down into everyday use by Drs and physiotherapists. Then in 1978 Harvard physician Dr. Gabe Mirkin coined the term RICE (Rest. Ice. Compression. Elevation.) as the recommended treatment for sports injuries in his landmark The Sports Medicine Book. Since this time, the medical community has religiously used this protocol for the treatment of all acute injuries.
The belief is that ice reduces pain, inflammation and swelling supposedly reducing the recovery time.
The science
This is where the literature since disagrees. Dr Mirkin has even retracted his assertions, stating, “Subsequent research shows that ice can actually delay recovery.” And also concluding, “today, RICE is not the preferred treatment for an acute athletic injury.”
When we get injured the body creates an inflammatory response. This is a good thing. It is a bit like someone dialing 000 and seeking assistance from an ambulance, the police and the fire brigade.
White blood cells rush to the site to begin the healing. More specifically neutrophils (for an open wound) and macrophages are called upon to start the clean up process. As they swarm around collecting all the fragments, IGF-1 (a growth hormone) is released, starting the cellular regeneration and muscle repair phase.
The Problem
Ice acts as a roadblock to these processes slowing down the process by up to 65%, to the point sometimes the injured site does not fully repair.
Swelling too is largely misunderstood and miscategorised. Swelling is the result of the clean up crew gathering so much waste product but not extracting it. The way the body naturally extracts these waste products is through lymphatic drainage.
The lymphatic system is a series of tubes much like veins and arteries. Unlike veins though there is no mechanical heart like pump to create the energy for fluids to travel through the pipes. The lymphatic system works by your muscles contracting and squeezing, compelling the system along.
The solution
Immobilising the body post injury to reduce swelling would then also seem to be a bad idea. If swelling is just a by product of the immune response and the way to help the body naturally carry away the debris is to move – relatively pain free movement then is the solution.
Gently and continuously removing the waste products with exercises like an isometric contraction (where is a single joint is held in a steady state) should not only help with swelling but also minimise muscle wastage. Which is one of the main issues returning athletes have post injury.
In 2005 researchers conducted a meta-analysis (meaning a study of all available studies) on the use of cryotherapy directly after ACL reconstruction surgery. They concluded that the only benefit was in lowering pain. Icing did not improve how much the person could move their knee or lead to any decreases in swelling.
Ice does have many benefits and I continue to use cold-water therapy as a protocol for my clients and me. I just don’t use it to assist directly in the recovery of acute injuries.
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