Ice Age Melting: Rice May No Longer Be the Treatment of Choice for Injuries

RICESince 1978 when Dr. Gabe Mirkin coined the term RICE, Rest, Ice, Compression, and Elevation have been the gold standard for treating athletic injuries. But now the ice age is melting, and a series of studies that show that injury treatment with cold therapy and total rest may actually delay healing has even Dr. Mirkin changing his mind.

Saying not to ice an injury is controversial because everyone does it, including athletes, trainers, and physicians. The new line of thinking has caused extensive debate among experts who have relied on RICE for decades.

Ice has been the standard injury treatment for sore muscles and injuries because it helps relieve pain and swelling, and inflammation is considered bad. But current information shows that inflammation is the body’s first physical response to repairing tissue, and without it healing does not happen.

Applying ice causes blood vessels around the injury to constrict and shut off the blood flow that brings in the inflammatory cells needed for healing. The vessels do not open again for hours after the ice is applied. Decreased blood flow can cause tissue to die and even result in permanent nerve damage. In addition, the ice reduces pain, which is an alert to avoid motion that may be harmful.

A study published in The Journal of Strength and Conditioning Research examined the influence of icing on muscle damage. Data from the study did show that icing delays recovery and should not be the first choice of treatment for injuries. After icing there was an immediate increase in swelling. Indicators of muscle damage increased after application of ice.

Applying ice causes blood vessels around the injury to constrict and shut off the blood flow that brings in the inflammatory cells needed for healing.

And research published in The American Journal of Sports Medicine in June, 2013, said that although icing an injury relieved swelling it did not make recovery from muscle damage quicker. If the treatment reduces inflammation it delays healing. This includes the use of anti-inflammatory pain relievers like ibuprofen.

Inflammation is the same biological process used to kill germs in the case of illness or infections. If germs get into body the immune system sends proteins and cells into the infected area to kill them. When muscles are injured the immune system sends the same cells to promote healing in the damaged tissue.

Inflammatory cells called macrophages release hormones into the damaged tissues that help them heal. Applying ice to reduce swelling prevents the body from releasing the hormone and delays healing. This was shown in a Cleveland Clinic study published in the Federation of American Societies for Experimental Biology in November, 2010. The lymphatic system will naturally remove the swelling when the healing is done.

Mirkin, who wrote the Sportsmedicine Book in 1978 that introduced RICE, said last month that an injured person should stop exercising, although not resort to complete inactivity, since total rest also does not stimulate tissue repair. Complete rest causes tissue to waste, so he recommends using light exercise as a repair stimulus.

Mirkin says it is okay to apply ice for pain relief immediately after the injury occurs, but for short periods only. He suggests icing for 10 minutes, removing the ice for 20 minutes, and repeating the process once or twice, but stresses that there is no reason to continue icing more than six hours after injury. If the injury includes broken bones, loss of consciousness, or an inability to move, go to the doctor!

According to The American Journal of Sports Medicine in January, 2004, ice plus exercise may be of some help in healing ankle sprains.

A new acronym, MCE, replaces the old standard RICE, and leaves out cold therapy for injury treatment. MCE stands for Move safely when you can as much as you can, Compress, and Elevate. The ice age is melting.

By Beth A. Balen

Strong Athlete
Athletic Medicine
Athletic Medicine
mobility wod

31 Responses to "Ice Age Melting: Rice May No Longer Be the Treatment of Choice for Injuries"

  1. Cat   September 22, 2015 at 3:26 pm

    John: Move safely when you can as much as you can, Compress, and Elevate

  2. Sean Davis   September 2, 2015 at 4:47 am

    Sounds logical, but then surely compression and elevation would also be counter productive? Both of these things would also reduce circulation and the number of inflammatory cells around the injury.

  3. JOHN LAMA   August 28, 2015 at 11:04 am

    Then what is the first treatment/aid for sports injury???

  4. sai kamal   August 20, 2015 at 6:20 pm

    After applying ice as per rice protocol to the muscle injury for the athletes . I think we have forgot the concept of hunting reaction in the body after applying ice so that process promote the healing

  5. Dave   August 20, 2015 at 11:02 am

    The only study you referenced that I could find (thanks to sloppy linking) was the Cleveland Clinic study about genetically-modified mice. It was NOT about ice, cryotherapy, or anything remotely related to cooling therapy for acute muscular injuries. If anything, the ONLY thing it proves is that people shouldn’t be genetically-modified in a way that causes their body to not respond at all to an injury. You make a huge leap by thinking that a genetic modification in mice that inhibits ALL swelling is the same as short-term, intermittent ice therapy which only mildly reduces swelling. If they altered the genes of the mice so they inhibited 100% of the inflammatory process, there’s no way to tell what other effects of the healing process they altered on which ice would have little or no effect.

    If you’re going to write articles, you have a duty as a journalist to not only provide the correct references initially, but to follow up and make corrections/revisions as they are pointed out. Otherwise you do your name and reputation a disservice (as well as any website who publishes anything you write).

  6. T.K.Loh   August 19, 2015 at 2:58 am

    Do people forget about the principles and physiology?Ice will vasoconstrict and therefore restrict bleeding and should only be done for short duration of 20mins or so.thereafter for the site to return to its homeostatic temperature vasodilatation occurs hence speed up the healing process.thereafter to gently stretch out the part to encourage the muscle to heal in the line of pull/stress.

  7. Maryke   August 19, 2015 at 2:00 am

    Dear Beth can you please provide full references to the articles that you quote. The articles in the The Journal of Strength and Conditioning Research is usually related to exercise induced muscle damage and has a very different mechanism to acute tears of muscle and tendons in that there usually is not bleeding. Ice was thought to help recovery from that sort of damage but is now known to hinder it. There is however no research out on the effect on acute tears where it is thought to limit the extent of the injury due to limiting excessive bleeding and thus secondary injury.

    I could not find an article in The American Journal of Sports Medicine in June, 2013 that covered this topic for acute injuries.

    This is the only study out there regarding ice and acute muscle tears and since it is a pilot study with way to few subjects, we cannot make anything from this.
    The researchers also did not look into immediate application of ice but rather 6 hours after injury

  8. Megan   August 17, 2015 at 11:18 am

    You lost credibility when you said “trainer” not Atheltic Trainer.

  9. BigE   August 17, 2015 at 10:52 am

    I use ice for a bit then i put the foot in a bucket with warm water b4 i give it therapy, and my injuries clear up just find and with good recovery. …..

  10. mark williamson   December 7, 2014 at 11:31 pm

    This is not true. As soon as ice is removed there is a flushing of blood that is thought to help remove and restore an injury more quickly. It does not close off vessels for hours!


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