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Why the R.I.C.E Principle No Longer Applies

Rest, ice, compression, and elevation was the go-to first phase of treatment for injuries and pain for many years.


The rationale behind this treatment was to manage the redness, pain, and swelling that happens as a result of injury, i.e., inflammation.


The issue with trying to interfere with inflammation is that its part of the healing process and if we interfere with it, we hinder our healing process.


Studies as early as 2012 questioned the use of cryotherapy (ice) as a method of treatment for this very reason. (1) The idea of absolute rest was also called into question.


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


Protection

Optimal

Loading

Ice

Compression

Elevation


We didn't want to quite give up on ice at this point, but we did want to include the fact that early activity promotes recovery. Just protecting and resting it was only part of the solution.


Then we really began to question the role of ice. Despite how often and widespread its use was, there was no high-quality evidence to support the use of ice for treating soft tissue injuries. However, it was known that there was a short-term pain-relief effect, which did have some value. (2)


As such, in 2019 cryotherapy was completely revoked, leaving us now 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 aggregation)

Optimism (psychological factors)

Vascularization (promoting blood flow)

Exercise (promoting movement as therapy)


A few highlights to note from this:

  • protection, compression, and elevation were still present, highlighting their importance for acute injury treatment

  • education and optimism were added to the mix, further demonstrating the importance of the psychological effects of injury and pain and how they can affect the effectiveness of our recovery

  • bringing blood flow to the area (vascularization) and getting it moving (exercise) were added to emphasize how exercise therapy helps restore mobility, strength, and confidence after injury (3). And all of this replaced ice and elevation which decreased blood flow and movement capability


Despite the popularity of applying ice to manage injuries, the evidence for its use doesn't back it up. Although it can provide pain relief in the short term, it can actually hinder our healing process as mentioned before.


With all of this, we do have to keep in mind that the evidence is currently evolving on the topic and this protocol was developed very recently (2019), so it can very well change as we discover more. However, we do now know that movement is a bigger part of injury treatment than before, as well as resting and icing it is not.


I'm curious as to your experience, do you or have you used ice to manage acute injuries before? Let me know down below!


To your good health,

Coach Stephen


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