I’m sure you’ve heard of the R.I.C.E. protocol. If not, you’ve definitely done it. How many times have you heard, when you got hurt, to rest, ice, compress, and elevate your injury? Probably one million? I’m sure your doctor, physical therapist, or mom have told you this at one point in your life.

It turns out that icing your injuries is one of the worst things you can do. I understand that you’re a little skeptical. That’s fair. We don’t like learning that everything we knew was a lie. Read on to find out why your mom, physical therapist, and family doctor have been so wrong for so many years.

Let me give you a little history lesson. The year is 1978. A young Gabe Mirkin, M.D. coins the term R.I.C.E. in an effort to treat sports injuries in The Sports Medicine book.

Okay, that story wasn’t that exciting. However, fast-forward 36 years, and the same Dr. Mirkin writes a foreword in the book Iced! The Illusionary Treatment Option by Gary Reinl. He states that ice may actually delay recovery. He then goes on to say that “RICE is not the preferred treatment for an acute athletic injury,” (Reinl).

After coining the infamous RICE protocol, Dr. Mirkin tells us all that he was mistaken. That Ricing your injuries away might not actually work. I respect Dr. Mirkin’s humility. In 2015, he wrote a blog post titled Why Ice Delays Recovery. He not only claims that ice delays recovery, but it also reduces strength, speed, endurance, and coordination. Obviously, none of these are ideal if you are trying to be an athlete. Or even just a fit human. They might be ideal if you are trying to be a professional couch potato, but I’m sure that’s not very lucrative. (Dad joke, sorry.)

Why have we been told to ice so much? Common knowledge has told us that it helps reduce inflammation and swelling.

Well, it turns out that we may have been misguided in that pursuit. Dr. Kelly Starrett, physical therapist and author of Becoming a Supple Leopard stated that we should be asking two questions when it comes to choosing ice for recovery:

• Is the body’s healing response a mistake?
• Does icing help my body remove the congestion from the injury? (Starrett)

Is the body’s healing response a mistake?

The reason for the first question is because the R.I.C.E. method was designed around limiting the body’s healing response. Don’t know what the body’s healing response consists of? You’ve probably heard of inflammation, which is one aspect of the body’s healing response. You’ve also probably heard of swelling, which is due to “leftover” material from the body’s healing response that hasn’t been cleared by your body’s lymphatic system. The lymphatic system is the system of your body that deals with any immune response to damage or disease.

We have condemned these aspects of our immune system. We have seemed to, for whatever reason, convinced ourselves that inflammation is bad. So, what do we do? We rest (turn off the muscle completely to decrease blood flow to it), ice (freeze it to decrease circulation to that area), compress (squeeze it to further prevent circulation to an area), and then elevate (you get the point) the injured area.

Gary Reinl, the author of Iced! The Illusionary Treatment Option, argues that we have to change our perspective.

“What “icing does very simply is [...] it prevents the natural flow of oxygen supplies and causes additional damage.”

— GARY REINL

In an interview on the topic with Dr. Kelly Starrett, he claims that what “icing does very simply is [...] it prevents the natural flow of oxygen supplies and causes additional damage,” (Starrett).

When our tissues become inflamed, it is our body sending oxygen supplies and other healing elements to the damaged site for repair. The R.I.C.E. protocol does everything possible to prevent that. So, instead of fighting our body’s immune response, we should assist it. Well, how do we do that? We will discuss that after we explore the second of Dr. Starrett’s questions:

Does icing help my body remove the congestion from the injury?

In Iced! The Illusionary Treatment Option, Reinl further explains to us that swelling, or congestion, isn’t because the body sent too much fluid to the damaged site, “it’s because too little fluid has yet been moved through the lymphatic system.” (Reinl).

Then what does ice do? It freezes everything in place, essentially. So we cannot clear any of the by-products of the immune response from the area. This congestion can actually lead to further tissue death by “suffocating” the tissue. That is not ideal. When we are dealing with injury, we want to promote circulation, waste decongestion, and tissue reorganization (healing) to prevent scar tissue creation and other bad things from happening.

So, how do we do that? Sheesh, be patient!

Why Was Ice Ever A Thing?

I want to dive a little bit into what might have been the cause of icing’s popularity and the strangeness of its popularity.

When you ice an injury, you numb the affected site. This can help decrease pain and make it “feel better.” It’s like taking an ibuprofen. Decreasing pain feels good. But, what happens when we remove the ice and the numbing goes away? More pain! Bummer.

“The strangeness comes from the fact that there is truly no evidence that backs up the usage of ice as an effective means of tissue recovery. ”

Also, decreasing pain is going to make it easier for our body to get into harmful positions because we don’t feel the pain that these harmful positions are causing. This is just an unfortunate and indirect side-effect of icing. Pain is an indicator that something is wrong. Would you want your smoke alarms to stop working just because you don’t like the noise they make?

Our goal should refocus from decreasing initial pain and instead healing faster (significantly faster, if you read the examples in Gary Reinl’s book).

The strangeness comes from the fact that there is truly no evidence that backs up the usage of ice as an effective means of tissue recovery. I implore you to read my references. Within my references are even more references that illuminate this idea.

One meta analysis (study of studies) I read (yes, I read sometimes) concluded that not enough "evidence is available from randomized controlled trials to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults.”  Then they go onto say that “treatment decisions must be made on an individual basis, carefully weighing the relative benefits and risks of each option, and must be based on expert opinions and national guidelines.” (van den Bekerom et. al.).

But, what if the experts have been wrong for the past 42 years (which they were) and the national guidelines are wrong (which they are). I was taught the R.I.C.E. method when getting my Bachelor’s in Exercise Science. I graduated in 2019. Scary.

If you are still not convinced, let me describe something to you that I’m sure you have heard of, especially if you have seen Mr. Deeds. If I sent you on a mission to the top of Mt. Everest with no gloves, what would happen to your hands? If I told you to stick your bare feet in some fresh snow from last nights blizzard for an hour, what then? That’s right, you’d probably get some degree of frostbite and kill and/or damage a whole bunch of the cells in that part of your body. So, why do we prescribe nearly the same thing when the tissues are already damaged?

Okay, I’m done with my diatribe. We know that ice isn't the right strategies for injuries. Now, onto the fun stuff.  

What Do I Do Instead of Icing?

When it comes to healing from injury, we are trying to do two things according to Reinl:

• Prevent Further Tissue Loss
• Restore Damaged Tissue

We need to help assist the body’s very effective healing system do its job. We want to encourage circulation, remove congestion, and promote the reorganization of damaged tissue.

What’s the most effective way to do that? What’s the best way to recover from tissue damage (including injury and soreness)? Unless your injury is extremely traumatic, here’s what to do:

Use active recovery to activate the damaged tissue.

If you don’t have access to electro-stimulation technology (I don’t, so I don’t know why you would) then you need to come up with some way of activating the tissue without causing pain or fatigue. I really liked this example that Reinl used in his book, so I’m going to steal it.

“Activating your quads, hamstrings, and hips up the chain will further assist in the recovery process even if you can’t wiggle your toes or flex your foot. ”

Let’s say you get a common ankle sprain. Depending on the circumstances, you are going to want to activate the muscles in and around the damaged site. Again, we are trying to not cause pain or fatigue. So, we should start with the smallest possible movement, like wiggling one toe, and then gradually move onto larger ones, like flexing the foot up and down.

This should come with this disclaimer: recovery techniques are not designed to get you stronger, they are designed to help you recover faster. That said, you are not wiggling your toes with maximal effort. You should do these movements as often as possible for as long as possible while staying within the guideline of zero fatigue and pain. Just so you don’t feel like you’re going crazy, the answer is yes: you could be spending hours everyday wiggling your toes if need be.

But, what if you have a boot on? That is no excuse to not activate your tissue. Activating your quads, hamstrings, and hips up the chain will further assist in the recovery process even if you can’t wiggle your toes or flex your foot.

There’s also this acronym going around called “M.E.A.T.” which I don’t like. It stands for “Movement,” “Exercise,” “Analgesics,” and then “Treatment.” However, some of the sources I’ve read say that it’s supposed to be done in that order. If that’s the case, why is treatment (meaning seeing a doctor, physical therapist, etc.) last? Just stick to Reinl’s acronym ARITA: Active Recovery is the Answer.

At the end of the day, life is strange. We say one thing when we should have said the other. We post guidelines without knowing the science behind it. Or, we post guidelines while knowing the science behind it, but not caring to apply it. Then, we wait 42 years to see if anyone realizes we were wrong.

Be skeptical, check your sources. Like I said, if you don’t trust me at face value, I implore you to examine my sources in more scrutiny than I did. When I posted online that I was writing this blog, I got back many: “Wait, ice is bad for recovery?” from many of my colleagues who’s opinions of the human body I respect. The field of strength and conditioning is very young, and that shows very often.

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References

Starrett, K., Dr. (2020, July 10). Trigger Warning: You've Got to Stop Icing! Retrieved July 11, 2020, from https://members.thereadystate.com/blogs/trigger-warning-youve-got-to-stop-icing/

Van den Bekerom, M. P., MD, Struijs, P. A., MD, & Bankevoort, L., PhD. (2012). What is the Evidence for Rest, Ice, Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults? Retrieved July 11, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396304/pdf/i1062-6050-47-4-435.pdf

M.E.A.T. vs R.I.C.E.: The New Age of Treating Acute Injuries. (2020, June 30). Retrieved July 11, 2020, from https://motusspecialists.com/meat-vs-rice/

-, D. (2020, June 22).

Dr. Gabe Mirkin. Retrieved July 11, 2020, from https://www.drmirkin.com/fitness/why-ice-delays-recovery.html

Reinl, G. R., & Starrett, K. (2014). Iced!: The illusionary treatment option. Henderson, Nevada: Gary Reinl.