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RICE for Acute Injuries?

by Racer X Virtual Trainer


Have you noticed when people are sick with a cough the first thing they do is reach for cough medicine to eliminate the cough that is our bodies way of clearing chest congestion? Or when people have a fever they immediately take medication to lower the fever that is our bodies natural response to killing off foreign invaders. And when athletes twist a knee or ankle they are quick to ice the injury to slow the inflammation that is the first physiological process to the repair and remodeling of tissue. Certainly there are valid reasons to take medications that help fight disease and illness as our bodies are not perfect and need a little help from time to time. In the athletic world coaches and trainers have been using the RICE (Rest, Ice, Compression, Elevation) guideline to treat acute injuries for decades. It is widely accepted and so commonplace that suggesting otherwise is laughable to most. But when the doctor who coined the term comes out and says he may have been wrong, then I think it is warranted to investigate and find out what lead him to this conclusion.

The following article is not meant so much to change your mind on the RICE guidleines but more to expose you to the science behind the coining of the term and why the Doctor is changing his mind. After reading the article I'd encourage each of you to also read this article and pay particular attention to the comment section. The comments are extremely educational! - Virtual Trainer

Reposted from
By Gabe Mirkin, MD

Injuries in motocross happen almost every race and riders typically are very good about icing an injury. However recent research suggests that the widely used RICE guideline for treating acute injures may not be as good as we once thought. Use ice with caution.

photo - Cudby

When I wrote my best-selling Sportsmedicine Book in 1978, I coined the term RICE (Rest, Ice, Compression, Elevation) for the treatment of athletic injuries (Little Brown and Co., page 94). Ice has been a standard treatment for injuries and sore muscles because it helps to relieve pain caused by injured tissue. Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping. In a recent study, athletes were told to exercise so intensely that they developed severe muscle damage that caused extensive muscle soreness. Although cooling delayed swelling, it did not hasten recovery from this muscle damage (The American Journal of Sports Medicine, June 2013). A summary of 22 scientific articles found almost no evidence that ice and compression hastened healing over the use of compression alone, although ice plus exercise may marginally help to heal ankle sprains (The American Journal of Sports Medicine, January, 2004;32(1):251-261).

Healing Requires Inflammation
When you damage tissue through trauma or develop muscle soreness by exercising very intensely, you heal by using your immunity, the same biological mechanisms that you use to kill germs. This is called inflammation. When germs get into your body, your immunity sends cells and proteins into the infected area to kill the germs. When muscles and other tissues are damaged, your immunity sends the same inflammatory cells to the damaged tissue to promote healing. The response to both infection and tissue damage is the same. Inflammatory cells rush to injured tissue to start the healing process (Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999). The inflammatory cells called macrophages release a hormone called Insulin-like growth Factor (IGF-1) into the damaged tissues, which helps muscles and other injured parts to heal. However, applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1.

The authors of one study used two groups of mice, with one group genetically altered so they could not form the normally expected inflammatory response to injury. The other group was able to respond normally. The scientists then injected barium chloride into muscles to damage them. The muscles of the mice that could not form the expected immune response to injury did not heal, while mice with normal immunities healed quickly. The mice that healed had very large amounts of IGF-1 in their damaged muscles, while the mice that could not heal had almost no IGF-1. (Federation of American Societies for Experimental Biology, November 2010).

Ice Keeps Healing Cells from Entering Injured Tissue
Applying ice to injured tissue causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation (Knee Surg Sports Traumatol Arthrosc, published online Feb 23, 2014). The blood vessels do not open again for many hours after the ice was applied. This decreased blood flow can cause the tissue to die from decreased blood flow and can even cause permanent nerve damage.

Anything That Reduces Inflammation Also Delays Healing
Anything that reduces your immune response will also delay muscle healing. Thus, healing is delayed by:

  • cortisone-type drugs,
  • almost all pain-relieving medicines, such as non-steroidal anti-inflammatory drugs like ibuprofen (Pharmaceuticals, 2010;3(5)),
  • immune suppressants that are often used to treat arthritis, cancer or psoriasis,
  • applying cold packs or ice, and
  • anything else that blocks the immune response to injury.

Ice Also Reduces Strength, Speed, Endurance and Coordination
Ice is often used as short-term treatment to help injured athletes get back into a game. The cooling may help to decrease pain, but it interferes with the athlete’s strength, speed, endurance and coordination (Sports Med, Nov 28, 2011). In this review, a search of the medical literature found 35 studies on the effects of cooling . Most of the studies used cooling for more than 20 minutes, and most reported that immediately after cooling, there was a decrease in strength, speed, power and agility-based running. A short re-warming period returned the strength, speed and coordination. The authors recommend that if cooling is done at all to limit swelling, it should be done for less than five minutes, followed by progressive warming prior to returning to play.

My Recommendations
If you are injured, stop exercising immediately. If the pain is severe, if you are unable to move or if you are confused or lose even momentary consciousness, you should be checked to see if you require emergency medical attention. Open wounds should be cleaned and checked. If possible, elevate the injured part to use gravity to help minimize swelling. A person experienced in treating sports injuries should determine that no bones are broken and that movement will not increase damage. If the injury is limited to muscles or other soft tissue, a doctor, trainer or coach may apply a compression bandage. Since applying ice to an injury has been shown to reduce pain, it is acceptable to cool an injured part for short periods soon after the injury occurs. You could apply the ice for up to 10 minutes, remove it for 20 minutes, and repeat the 10 minute application once or twice. There is no reason to apply ice more than six hours after you have injured yourself.

If the injury is severe, follow your doctor’s advice on rehabilitation. With minor injuries, you can usually begin rehabilitation the next day. You can move and use the injured part as long as the movement does not increase the pain and discomfort. Get back to your sport as soon as you can do so without pain.

Remember, if you want to dive into this topic even further, I highly suggest reading this article and take some time to read and study the comment section. It's a great read!

That's it for now, until next time, good luck with your training and remember, if you have a question, log on to the Virtual Trainer Expert Forum and have your question answered by a panel of experts. In addition, be sure and check out the Racer X Virtual Trainer archive section. Your complete one-stop information zone for motocross fitness. VT Signature

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  1. Gravatar
    Justin A. April 28, 2014 at 8:08 pm

    I am a licensed athletic trainer and amateur racer been telling my friends the same thing for years, great info!

  2. Gravatar
    Coach Seiji April 29, 2014 at 11:47 am

    Inflammatory response is necessary and good. Swelling is not. Elevation and movement under compression will reduce and mechanically move swelling out of the effected area, reducing the impact on movement and performance. I have to agree that icing is good for pain relief but that is it. I have to admit that I followed the standard icing protocol for a long time but after researching and relatively new information, I have not used icing at all hardly for anything other than a very temporary reduction to acute pain.

  3. Gravatar
    Joshua Stone January 26, 2015 at 6:11 am

    First and foremost, thank you for sharing this. I am the author of that website and that article. I too am a huge MX/SX guy and raced from 3 - 24 yrs of age. Now my son, is about ready to swing his leg over the back of the bike. So, seeing my content being shared with Coach Seiji and RacerXVT is awesome.
    I've been passionate about icing injuries for a long time. There is no evidence to support it. In addition to the article you have here, I have 4 or 5 others on my site that talk about other forms to therapy compared to ice. It drives me nuts.
    And coach Seiji is correct, swelling and inflammation are two different entities. Many, do not understand this. Swelling must be removed - lets use other tools to facilitate swelling removal, let's not stop inflammation to stop swelling.
    In regards to racing - thanks coach Seiji for putting out good programs. Very few now how to train riders. Cheers - Josh Stone, MA, ATC, CES, PES, CPT

  4. Gravatar
    Racer X Virtual Trainer February 02, 2015 at 1:12 pm

    Josh - If you would like to contribute to the website, please contact me

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