What Is R.I.C.E. and Where Did It Come From?
Back in 1978 Dr. Gabe Mirkin coined the acronym R.I.C.E. (rest, ice, compression, elevation) in his book, The Sportsmedicine Book. It described the method for treating injuries, typically when referring to athletes, to achieve recovery. It took over as the model for how to treat injuries in the general population as well, with it being a common recommendation given by doctors and nurses.
As studies advanced our understanding of the human body and how it functions, Dr. Mirkin’s treatment method became controversial, with many arguing against the methodology entirely. It even led to Dr. Mirkin retracting his recommendation in 2014 and acknowledging that it actually was more likely to inhibit healing and recovery. However, the debate rages on, and even to this day some doctors still recommend his R.I.C.E. treatment to their injured patients. So why don’t we examine what we do know so far about treating injuries and what best practices might be.
How Inflammation Actually Helps Healing
If you’ve ever stubbed your toe or rolled your ankle you know how frustrating and annoying of an injury that can be. Nothing is majorly wrong with you but it now hurts to put weight on your foot which severely limits the freedom of movement that you’re typically used to. In a perfect world you could just go back in time and not wear flip flops to the grocery store, but unfortunately time travel hasn’t been invented yet. So let’s take a look at the situation instead.
Generally the first thing that happens is inflammation. This is where damaged blood vessels “leak” out fluid in order to stabilize the joint and bring in healing cells. A side effect of this usually means that the joint has very limited mobility because everything is so stiff from the inflammation. According to R.I.C.E., the treatment would be to get off your feet and put ice on it to reduce the inflammation, and then use elevation to inhibit fluid from overwhelming the joint again by using gravity, once the ice is removed.
I’m sure you can see how this would interfere with your body's chosen way of addressing the injury. But here’s where it gets tricky on both accounts. Your body is reacting to the injured area with its straightforward approach of stabilizing and immobilizing the joint and flooding it with healing fluid. It wants to prevent further damage to the tissues while preserving and repairing what has been damaged. This makes it difficult and painful to move though, which lead to the seemingly reasonable approach that you would reduce the inflammation with ice and then just stay off your feet, since it seems like that’s what your body wants anyway. The problem with reducing the inflammation is that you’re removing the stabilizing fluid and the healing process the fluid provides. So instead you leave it alone and hobble around, putting a little weight on it here and there to test it. Only this isn’t such a great approach either.
The Role of The Lymphatic System In Injury Recovery
This is where an understanding of the lymphatic system is helpful. This is your “drainage” system. It’s what removes the fluid from the area, taking damaged cells and tissues with it. This allows for oxygen and nutrient rich blood to get to the area for healing. When you injure yourself in this way, the surrounding blood vessels “leak” out fluid called exudate. While this fluid contains proteins and plasma and other healing cells, the severity of the injury can cause too much fluid to come out of the blood vessels, which is what causes the painful type of inflammation. So helping your body to manage the inflammation can be extremely beneficial. And it’s also a good reason not to fully demonize the R.I.C.E. system.
Your lymphatic system doesn’t have a pump, like your heart, to keep things moving. It relies on your physical movements and your circulatory system to push it along. It’s one of the many reasons exercise is good for you, because when your heart rate elevates blood pumps faster through your body, so during exercise your lymphatic system functions more optimally due to your physical movements as well as the increase in blood circulation.
But the lymphatic system can also be manipulated in other ways, specifically here with ice. Ice restricts blood vessels and pushes fluid out of the surrounding area. A.k.a. reducing inflammation. One type of treatment I’ve found helpful is a form of what is called Contrast Therapy.
What Is Contrast Therapy?
Contrast Therapy is the method of using cold and heat to “push” fluids out of the area and then “pump” blood in. Ice can reduce inflammation, pushing fluid carrying damaged cells and tissue out of the area and into the lymphatic system, freeing up mobility and allowing you to both move the joint and the tissues around it. Then heat is applied to open up the blood vessels and pump blood in.
The difficult part here is to know how and when to use these techniques because that can be dependent on several factors, like how badly the tissue is damaged, how healthy is the individual who was injured, and whether there are any unrelated, underlying health conditions. It is generally recommended that heat not be applied to any type of inflammation before 48 hours. I somewhat disagree with this recommendation because healthier people respond well to contrast therapy just fine if it is managed right with regard to properly dosing the inflammation with what I like to call, “flushing”.
Why Movement Is Important After An Injury
The other important factor here is movement. For this I would probably stick with a 24-48 hour restriction unless the injury isn't too bad and you know what you’re doing, or have someone who does. Gentle, progressive movement is what is now going to address the health of the tissues functioning.
So, you have successfully managed the inflammation and the blood flow to help “clean out” damaged tissue and cells and bring oxygen and nutrient rich blood in, but now you want to begin to restore healthy lengthening and shortening of the injured muscle tissue, otherwise it remains stiff and poorly functioning.
For this example, after you have managed the inflammation aspect of your swollen ankle, and given consideration to how long you might need to wait to start getting the muscles to activate, I’d start by gently pressing the bottom of your foot on a tennis ball while you flex your foot up towards your shin and then point your toes away.. Remember, muscle functionality is judged on proper lengthening and shortening of the tissue. Since it was recently damaged, care must be taken in this stage to make sure it promotes healthy healing, and not unintentionally increasing the damage. You should incorporate a version of contrast therapy, or “flushing”, into the movement portion. Use ice to reduce inflammation and create a degree of desensitivity around the joint and in the muscle tissue, and then apply the tennis ball or whatever your chosen method is to open up and move the tissues, but after, apply heat to restore a healthy amount of blood flow back to the area to promote healing. I would most likely run my ankle under hot water until it returns to a normal temperature. This can be repeated probably 2-4 times.
Ice to reduce inflammation so the joint can move and not be as painful,
Pressure under the foot with some type of ball/object and then movement of the muscles/joint to promote functionality,
Then heat to move blood back into the area.
What Good Injury Recovery Support Looks Like
If this seems like it’s somewhat complicated, that’s because it is a bit. There are a multitude of factors that play a role in determining when you should apply these methods, to what level of intensity, and how to use the feedback from your body’s response to determine how you should proceed. I’m a firm believer in listening to your body and not giving in to “desired” outcomes that might run counter to what your body actually needs. But I also know a lot of people that aren’t connected to their body well enough to know what it’s telling them. Which is why it’s always helpful to have a knowledgeable personal trainer, coach, or physio on your team.
As always, please feel free to reach out with any questions, about this or anything else that you need more information on. And if this approach sounds like the type of training you would benefit from, please schedule a consultation and movement assessment. They’re free through June! Thanks for reading!