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.”
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.
Recommendation
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.
