Why I don't believe RICE (Rest Ice Compression Elevation) works

For most of my career as a health and fitness professional, the acronym “RICE” was thrown around by my professors, therapist, and physicians as a method of controlling inflammation and preventing injury. This post explores what I believe to be one of the biggest issues in the health and fitness industry. Lifelong learning is what I am about and with that, I am eager to change my approach if the science supports it. And if that means proving myself wrong at times, then I am okay with that. Icing areas of the body that have too much inflammation has been the norm for a long time. Growing up as an athlete, we were always told to go to the trainer’s room to ice down a sprained ankle or other minor injury. Soon after that we are popping over the counter fixes to speed up the healing process. Fast forward and now we have new ideas on inflammation and how our bodies naturally heal. Why are we using ice? The goal is to reduce inflammation right? But inflammation is the latter portion of a multi-step process. So are we saying that we are better at regulating the inflammatory response than the body is naturally? This is where science meets logic and I began to question these methodologies as I looked into more recent research on the inflammation process and its role in the healing process. Let’s talk about the inflammation response so we can gather a little background.

The role of inflammation in the process of healing has been misunderstood for many years. Recent neurological and immunological research has shed light on its importance in the human healing process. A clear shift in science is taking inflammation away from being the enemy of health and a condition to be suppressed and/or eliminated, to one in which its importance and role is allowed to proceed. The inflammatory response is a natural defense mechanism that is triggered whenever body tissues are damaged in any way. Most of the body defense elements are located in the blood and inflammation is the means by which body defense cells and defense chemicals leave the blood and enter the tissue around the injured or infected site. Inflammation occurs in response to physical trauma, intense heat and irritating chemicals, as well as to infection by viruses and bacteria. The inflammatory response:

(1) prevents the spread of damaging agents to nearby tissues (2) disposes of cell debris and pathogens and (3) sets the stage for the repair process.

The inflammatory process begins with chemical “alarms” - a series of inflammatory chemicals that are released in the extracellular fluid. Consequently, exudates - fluid containing proteins such as clotting factors and antibodies - seeps from the bloodstream into the tissue spaces. This exudate is the cause of the local edema or swelling that in turn, presses on adjacent nerve endings, contributing to a sensation of pain. Pain also results from the release of bacterial toxins, lack of nutrition to the cells in the area. If the swollen and painful area is a joint, normal movement may be inhibited temporarily in order for proper healing and repair to occur. Although at first, edema may seem to be detrimental to the body, but when you look at the science it clearly isn’t. The entry of protein-rich fluids into the tissue spaces (1) helps to dilute harmful substances, which may be present (2) brings in large quantities of oxygen and nutrients necessary for the repair process, and (3) allows the entry of clotting proteins which form a gel-like fibrin mesh in the tissue space that effectively isolates the injured area and prevents the spread of bacteria and other harmful agents into the adjacent tissues. It also forms a scaffolding for permanent repair.

So what should we do? We have to first understand that ice does not get rid of inflammation. It can bring core temperature down so we feel less pain but it also impedes the process of healing the affected tissue. We need to allow the lymphatic system do its job and restore our tissues to normal function. The lymphatic system serves several functions but the most important in this case is that it controls fluid balance by draining and cleansing the fluids that leave the circulatory system to deliver nutrients and gases to the tissues. In the circulatory system, our blood passes through the arteries, arterioles, and then the capillaries. The capillary walls allow the fluid portion of the blood to exit the capillaries into the surrounding tissues. Once the fluid leaves the capillaries, it is called interstitial fluid. About 90% of this fluid will diffuse back into the capillaries because of the difference in concentrations of the fluid. However, about 10% of the fluid will enter the open-ended lymph vessels. These vessels eventually deliver the lymph to locations where it can be cleansed of debris and checked for the presence of pathogenic organisms. How the lymph gets there is pretty amazing. There is no heart for this system of vessels to pump the lymph around. So, the lymph moves throughout your body by moving your skeletal muscles. The contraction of skeletal muscles squeezes the nearby lymph vessels, “pumping” the lymph through these vessels which helps us get rid of inflammation naturally.

Based on this recent research and approaching inflammation as a natural part of the healing process, here are some things that are actually effective in helping the body respond naturally:

1) Compression: Wrap the injured area in a light ace bandage. Doing this will help with stability of the area and also increase the body's ability to filter good oxygenated blood to the area. 2) Heat: Sitting in a hot tub or using a mild or low heat heating pad will also assist in filtering good oxygenated blood to the area. 3) Using Skeletal Muscles to your benefit: If the area is able to work under little to mild restriction of range of motion, try performing some very light exercise. Utilizing our ability to squeeze skeletal muscles at or around the injured area can also help the body deal with the inflammation naturally. 4) Electrical Muscle Stimulator: The use of these devices has increased dramatically in the last 15 years. They are now sold almost everywhere and can be beneficial in helping the body use skeletal muscles to help the lymphatic system do its amazing job.

References Wassung, K. (n.d.). The Role of Inflammation in the Healing Process. Retrieved from http://cichirowc.com/uploads/2012-01-30_Inflammation_and_the_healing_process.pdf