Why RICE is not so nice

By: Hana Pokornowski LAT, ATC

Everyone is familiar with using the RICE method after an injury (rest, ice, compression, elevation). As the times change, so do our views on the best treatment practices. As an athletic trainer, the most common questions I get asked after an injury include a few of the below…

- “Should I use ice tonight?”
- “What should I be doing at home?”
Or other questions along those lines. My answer to these questions surprised some people!

There is more and more research coming out that the RICE treatment method isn’t doing what we originally thought it was and that it might actually be delaying your recovery. Let’s dive into why that is…

Rest: 

As a verb 1) cease work or movement in order to relax, refresh oneself, or recover strength.
As a noun 1) an instance of period of relaxing or ceasing to engage in strenuous or stressful activity.

Okay, that’s good and all but another layman's way of saying the above is “doing nothing”. That is exactly what is happening when you rest with an injury - nothing! The body is stagnant at rest, and we certainly don’t want that when we are trying to bounce back quickly. The updated method we’d recommend instead of rest is quite the opposite - MOVEMENT! By implementing tolerable movement into your recovery process (starting on hour 0 of injury), you are promoting blood flow and preventing swelling from pooling in the area. 

Ice: 

As a verb 1a:) to coat with or convert into ice
1b:) to chill with ice

We have to ask ourselves - what is ice actually doing to an injured area when we apply it? Cold temperatures cause vasoconstriction (narrowing) of the blood vessels which slows blood flow. But we want (& need) this blood flow to happen! Increased blood flow is what gets the “clean up crew” to the injured area to start that healing process right away. Now on the other hand, ice can provide an analgesic (numbing) effect so if you are in intolerable pain (think 7,8 on the pain scale) in the first 24 hours after injury, don’t hesitate to use ice to decrease that pain. But if you are sitting at a 4,5,6 on your pain scale, try to hold off.

Compression and Elevation: 

Now these two, we don't have so much of a problem with. What you are doing when you apply compression or elevation is again preventing swelling from pooling in the area. Not a bad thing as long as you are pairing it with activity to keep the fluid moving. (See "Rest" above!)

Our Recommendations: P.O.L.I.C.E!

P.O.L - Progressive Optimal Loading

Keep the area moving to promote blood flow! That is certainly the main goal here. Perform some light exercise or range of motion movements to keep the soft tissues in the area mobile and to prevent them from stiffening up. Add weight and resistance as tolerated!

I - Ice
 

As stated above, feel free to use ice (up to 24 hours after injury) for pain management. Another pain management option would be to use NSAIDs as instructed. 

C. E - Compression and Elevation
 

These two when paired together can be helpful when done in conjunction with the other “right things”! Socks or sleeves for compression can help prevent swelling from pooling - same goes for elevation. Anything to encourage fluid moving toward the heart!

Seek treatment from your athletic trainer or physical therapist as soon as you can post injury so that they can give you further guidance on therapeutic exercises and provide you with a more structured recovery plan.

DID YOU KNOW?: Dry Needling Edition

There is a specific dry needling protocol that can help with swelling, but ideally it is done within 24-48 hours of injury. This protocol spams the area with If this is you, contact us right away and we usually get you in within that time frame! 

While this information is not the sole treatment plan for any and all injuries, this knowledge can certainly get you going on the right path minutes after injury occurs until you are able to seek further advice from a healthcare professional. If you have question on the above, let us know! We’d love to chat!