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Rethinking Recovery: Why the RICE Principle is Outdated

If you’ve ever dealt with a sports or common injury, you’ve probably heard of the R.I.C.E. principle: rest, ice, compression, and elevation. Rest is self-explanatory. Ice is commonly used to reduce swelling and painful redness at the site of injury. Compression and elevation have similar goals in preventing and managing inflammation and swelling.


There’s a fatal flaw to this plan. Why does the body trigger inflammation in the first place? It’s the body’s first response to damage, which involves sending resources (blood and immune cells) to the site of injury to remove debris, damaged tissue, and potential pathogens. This paves the way for new tissue growth to ultimately heal the injury.


Ice, compression, and elevation interfere with this entire process. Studies as early as 2001 questioned the use of cryotherapy (ice) as a method of treatment for this very reason. It decreases blood and resource flow to the site of application. The idea of absolute rest was also called into question.

And funnily enough, the guy who came up with the R.I.C.E. principle actually changed his views as new research came into light.

And so the R.I.C.E. principle became the P.O.L.I.C.E. principle.


Protection

Optimal

Loading

Ice

Compression

Elevation


The rationale here was that absolute rest results in too much deterioration of muscle and strength atrophy to be consistently recommended. Further disuse of an area of the body creates more risk of re-injury. Instead, optimal loading of the area while being conservative and protective where necessary became the standard. This way, we maintain the strength of the injured tissue while promoting mobility and driving more resources (blood flow) to the region.


Ice, compression, and elevation remained as part of the recommendation, but more to prevent excessive inflammation or to manage significant levels of pain.


Despite how often ice was prescribed, there was no high-quality evidence to support the use of ice for treating soft tissue injuries. However, its ability to provide short-term pain relief was still valuable.


A more recent study has built on this, stating, “Since the production of growth/healing factors is an intimate component of the regenerative process, it is not unreasonable to suppose that suppression of inflammation may alter the availability of such healing/growth factors, the consequence of which may be incomplete or extended healing time”.


Thereby, cryotherapy was completely revoked, leaving us with P.E.A.C.E. and L.O.V.E.


Protection

Elevation

Avoid anti-inflammatories (ice and drugs like NSAIDS)

Compression

Education (that active treatment trumps passive treatment)


Load (proper loading without aggravation)

Optimism

Vascularization

Exercise


It has been proposed that PEACE and LOVE management provides pain patients with greater education and understanding of the management of soft tissue injuries while aiming for favourable long-term outcomes.


There hasn’t been enough evidence found on cryotherapy and the application of the entire R.I.C.E. principle to warrant it as a valid strategy. Even when it is recommended, the frequency, duration, and general treatment practices aren’t well defined. How long should you rest? How long should you ice an injured tissue and at what intervals? How intense should compression be? These are all questions that don’t have a consistent answer.


PEACE and LOVE again better take into account various factors, even stating that avoiding anti-inflammatories and loading the tissue is optimal for healing, along with taking into account how your mindset affects the recovery process.


If we know all this, why do we still see so many people using ice and even high-level athletes doing so? Ice does still have its uses for short-term pain relief. It’s a Band-Aid at best, but it can still help you get by when you need to. When it comes to athletes, I would caution the use of their methods for the general population because they’re being paid millions of dollars to compete NOW and don’t often have the luxury of sitting out because of mere “soreness”.


That’s why you’ll see hockey players with literal bags of ice taped to their legs between periods and LeBron James sitting in an ice bath between playoff games. Oftentimes, they’re just trying to get by.


The advice I often give clients is this: if you’re in significant pain and need some relief, ice can work great; however, if you still feel like you need a good short-term relief method, use heat instead because it promotes more circulation and keeps the area feeling loose. Then, when possible, move to “Peace and Love” methods.


To your good health,

Coach Stephen

 Thanks for reading.


References (if you’d like to see the research for yourself):



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