Wednesday, July 5, 2017

Treating Injuries:

Are Rest, Ice, Compression, and Elevation Appropriate?

Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.”

 Gabe Mirkin, MD, March 2014

Dr. Mirkin first used the term Rest, Ice, Compression and Elevation (RICE) in 1978.  In the years that followed RICE became recognized as the standard of care for acute injuries (especially for the ankle).  RICE was actually later modified to Range of motion, Ice, Compression, and Elevation to reflect the need for movement after an injury.  Today, the original developer of the RICE protocol, Dr. Mirkin, now believes that both ice and rest may actually delay healing.  Inflammation is the body’s natural response to injury and brings in important healing factors.  By applying ice and compression early, we may inhibit swelling but this also inhibits the body bringing in important cells to begin the healing process.  Attempting to inhibit swelling early on may actually delay healing.  Additionally, Dr. Mirkin has found that “Anything that reduces your immune response will also delay muscle healing, such as cortisone-type drugs, pain-relieving medicines like NSAIDS, immune-suppressants, and applying cold packs or ice.” 

So what is the answer?

Reducing an athlete’s symptoms requires load management.  Isometric (holding against resistance while not moving) contractions have been shown to be analgesic and pain reducing.  It is important to factor in stage of tendinopathy and treat it as part of a well-rounded rehabilitation program involving kinetic chain exercises, education in proper landing technique, and management of load and return to sports.   Additionally, children heal faster and require little external help except management of pain and loading for short periods of time.


Avoid ice, NSAIDs, or other corticosteroids early on.  A short bout of 3-5 minutes of ice may be appropriate for pain management to allow the athlete to movement and begin load management as soon as possible.

Rudavsky A, Cook J. Physiotherapy management of patellar tendinopathy (jumper’s knee). Journal of Physiotherapy. 2014.  60: 122–129.

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