For a long time, an ice pack has been the first thing that comes to mind for anyone who sustains a sprain or strain injury, and the RICE protocol the preferred method of treatment for injuries. Ever since 1978 in fact, when Dr Gabe Mirkin first published the RICE protocol in his publication “Sports Medicine Book” [1].
The RICE Method
Rest
Resting, stopping or changing the activity where injury occurred serves to reduce pain and protect the injured area from any further damage.
Ice
Apply ice to the affected area as soon as possible. Ice can be applied in the form of an ice pack, or crushed ice in a bag, to reduce pain, inflammation and swelling [2-4].
Compression
Wrap the injured area with an elastic bandage or compression sleeve to help decrease swelling [5].
Elevate
Elevate the injured area while applying ice and anytime you’re resting. Try and keep the injured area above your heart to reduce blood flow and help minimise swelling.
Sounds good, but does the RICE method really help with recovery? Not as well as you’d think.
Rest following injury does not enhance the recovery process, instead it leads to an accumulation of waste products (lymph) at the damaged site [6]. These waste products are moved by the lymphatic system, which requires movement to propel lymph through the system. The lymphatic system doesn’t have a pump like the heart for the vascular system, and relies on muscle contractions to create pressure.
Anything that reduces inflammation also delays healing [7], and inflammation is key to the success of the healing process. Ice actually does not reduce swelling or an accumulation of lymph, and can even result in an increase in swelling [8]. Ice can also keep healing cells from entering injured tissue [4].
Compression and Elevation are also relatively un-supported clinically, and most support of their use is anecdotal [6]. That being said, there is little chance of any negative effects from using these methods post injury, and they may have a place in recovery via placebo.
Is there a better way?
Yes! There have been several other methods developed that focus on healing through active movement, to replace the RICE method.
In fact, Dr Mirkin has himself publicly changed his opinion on the RICE method [7].
Moving early in the recovery process is the key to alternative methods, and this has more benefits to recovery than extended periods of inactivity [9].
This is exemplified by methods such as MOVE and MEAT.
The MOVE Method
Movement Options Vary Ease
Movement is the first step in the recovery process. Movement is emphasised to be included as early as possible in the recovery process [10].
The remaining three aspects of the MOVE method, Options Vary and Ease, suggest using a variety of movement methods (E.g., strength, balance, and agility exercises) to assist the recovery process. The Move method also promotes early return to activity (EASE) to help athletes cope with the emotional cost of being injury.
The MEAT method
Perhaps the best method for replacing RICE is the MEAT method.
Movement
Move the damaged area through the full range of motion that can be achieved pain free. This serves to create the propulsive force to remove the waste products created through by the inflammatory response to injury, needed by the lymphatic system.
Exercise
Exercise with resistance is the next step beyond basic movement. Gradually add resistance to the movement to progressively regain strength and ability at the damaged site.
Analgesia
Analgesia is the inability to feel pain. This step suggests the use of pain-killers to allow for the injured area to be moved. Importantly, remember that anything that reduces inflammation also delays healing [7]. Commonly used NSAIDs (nonsteroidal anti-inflammatory drugs) for example, Ibuprofen, will not accelerate and may even hinder the recovery process[11]. Instead, a natural analgesic such as Turmeric may be a better option [12].
Treatment
The final stage of the MEAT method is to seek professional treatment. A broad category, and the choice of treatment may be influenced by the injury, but may consist of services such as physiotherapy, or acupuncture.
So, next time you roll your ankle, or sustain any sprain or strain, think MEAT not RICE. Movement really is the panacea for injury.
References
1. Mirkin, G., The sportsmedicine book. 1978: Little Brown.
2. Kellett, J., Acute soft tissue injuries--a review of the literature. Medicine and science in sports and exercise, 1986. 18(5): p. 489-500.
3. Mac Auley, D.C., Ice therapy: how good is the evidence? International journal of sports medicine, 2001. 22(05): p. 379-384.
4. Singh, D.P., et al., Effects of topical icing on inflammation, angiogenesis, revascularization, and myofiber regeneration in skeletal muscle following contusion injury. Frontiers in physiology, 2017. 8: p. 93.
5. Hansrani, V., et al., The role of compression in the management of soft tissue ankle injuries: a systematic review. European Journal of Orthopaedic Surgery & Traumatology, 2015. 25: p. 987-995.
6. Scialoia, D. and A. Swartzendruber, The RICE Protocol is a MYTH: A Review and Recommendations. The Sport Journal, 2020. 19.
7. Mirkin, G. Why ice delays recovery. 2015. DOI: www.drmirkin.com/fitness/why-ice-delays-recovery.html.
8. Meeusen, R. and P. Lievens, The use of cryotherapy in sports injuries. Sports medicine, 1986. 3: p. 398-414.
9. Buckwalter, J.A. and A.J. Grodzinsky, Loading of healing bone, fibrous tissue, and muscle: implications for orthopaedic practice. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 1999. 7(5): p. 291-299.
10. Robinson, J. MOVE an injury not RICE, 2018. DOI: https://thischangedmypractice.com.
11. Stovitz, S.D. and R.J. Johnson, NSAIDs and musculoskeletal treatment: what is the clinical evidence? The Physician and Sportsmedicine, 2003. 31(1): p. 35-52.
12. Maroon, J.C., J.W. Bost, and A. Maroon, Natural anti-inflammatory agents for pain relief. Surgical neurology international, 2010. 1.
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Daniel Glassbrook, PhD
Daniel is a sports scientist and researcher, currently working as the first team sports scientist for the Newcastle Falcons Rugby Club, and as a postdoctoral researcher in sports related concussion at Durham University.
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