BLOG: The "Ice" in RICE Treatment No Longer Recommended

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by Marlene Mayman | Apr 30, 2014 | Foot, Pain, Research

Ice.Ice has been recommended by medical professionals for decades as a suitable treatment to reduce inflammation and speed recovery from injury. Now that is changing, as new evidence comes to light.

Dr. Gabe Mirkin was an original proponent of using ice on injuries. In 1978 he coined the oft-used term “RICE” for his treatment approach: Rest, Ice, Compression and Elevation. (You may have heard Dr. Mirkin on the radio or seen him at his Kensington, MD office. I was once a patient of Dr. Mirkin some 20+ years ago.)

But that’s all changed. Two months ago Dr. Mirkin retracted his recommendation to include ice in the protocol, due to the lack of evidence for cryotherapy benefits. This follows on the heels of other articles that advocate non-ice treatments.

One such counter-point is by Erik Dalton, a well-known and widely respected myoskeletal bodyworker and the founder and Executive Director of the Freedom from Pain Institute. In his article, ICING For Injuries May Not Be So COOL, Dalton writes, “I have found RICE to have reduced efficacy in the management of acute ligament and tendon sprains.” Instead, the author recommends MEAT, or Movement, Exercise, Analgesic and Treatment.

In another article focusing on ankle sprains, Should POLICE Replace RICE as the Ankle Therapy of Choice?, the author quotes Doctor of Physical Therapy Eric Robertson, saying, “This RICE construct doesn’t necessarily reflect modern science.” Further, researchers at the National Athletic Trainers Association (NATA) “spent 6 years combing through the literature and assigning letter grades from ‘A’ to ‘C,’ from best to worst quality of the evidence behind each possible therapy,” with RICE falling largely into the “C” group for lack of evidence that it works.

For ankle sprains, what got an “A” from the NATA?

  • Functional rehabilitation (proper movement)
  • Balance training
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) … but only after two days have passed since the injury, so they don’t interfere with the body’s beneficial inflammation.

A last article worth perusing is Joshua Stone’s controversial Why Ice and Anti-inflammatory Medication is NOT the Answer. Based on the foundational 1986 study, The Use of Cryotherapy in Sports Injuries, Stone  observes that, “Ice can increase swelling and retard debris removal!”

All that said, for the layperson the RICE protocol may still be worth following if you’re injured on Sunday and it’s going to be a day before you can get to your doctor. Just understand there may be a better treatment and that your doctor or health practitioner should consider alternatives to RICE.

In the past I’ve recommended ice to clients experiencing inflammation, but I will be reticent to do so in the future. Yes, ice can help limit secondary damage from inflammation that spreads into surrounding healthy tissue, but is that worth it if your overall healing process takes longer? I’m guessing that most folks would say, “No!”

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