Rethinking RICE: A Better Way to Treat Injuries

July 16, 2015 at 5:43 pm / by admin

Have you ever a big old nasty sprained ankle? Have you ever limped into the doctor’s office for treatment? Have you ever heard the acronym RICE? We are willing to bet that you have.

RICE is considered the go-to treatment for sprained ankles and various other body parts. Here’s what it means:

Rest: Rest the sprain by keeping off of it. Don’t put weight on it. Lay around on the couch if you can.

Ice: Ice it down to keep the swelling down. Keep the ice directly off the skin, though, and only do it for about 20 minutes at a time, because you might get frostbite.

Compression: Wrap it up! Get a pressure bandage on it!

Elevation: Prop your foot above the waist if you are sitting, or above the head if you are lying down. This slows the blood flow to the affected area.

Get it? Lie down! Wrap it up! Dump ice on it! Stick your leg in the air! And wait! And maybe the doctor will give you some anti-inflammatory medicine if you’re lucky. So the end result of all this is that it’s supposed to cause the swelling and inflammation in your ankle to go away quicker, and if that happens, that means that your ankle will have totally healed, because the swelling is the key sign that your ankle is sprained, right?

Actually, no. We are not big fans of the RICE method of sprain healing, (or treating any other form of injury) and if you’ll bear with us, we will be glad to tell you why.

Inflammation and Swelling Serve a Purpose

When you sprain your ankle, that swelling that occurs is not merely decorative in nature. It’s actually serving a pretty important function. Swelling is increased blood flow to an injured area, it also causes a sort of barrier to keep stuff around the affected area, like a dam. Blood has this wonderful tendency to go and congregate where it is most needed. And it is definitely needed in an injury. So why on earth would you want the swelling to go down when it’s needed to help heal?

And why would you want anti-inflammatory drugs when inflammation helps the healing process work quicker? See this article on NSAIDS.

Ice, compression, and elevation all slow down the blood flow to a sprained ankle. And while you might be thinking that rest is the one thing here that works, but that isn’t effective either. Resting does nothing to help you rehabilitate your injury or get its strength back.

In other words, RICE actually gets in the way of allowing the body to heal sprains.

By the way, we aren’t just pulling this out of thin air. There has been quite a bit of dispute in medical rehabilitation circles recently about whether RICE is effective, or whether it’s the exact opposite of effective. And interestingly enough, one person doing a lot of the disputing is the guy who actually came up with the RICE acronym back in 1978. Dr. Gabe Mirkin wrote a book called Sports Medicine Book that’s still in use today, and at the time, Rest, Ice, Compression and Elevation seemed to be the obvious way of doing things.

But thinking can change in medicine, and so can evidence. Dr. Mirkin is now of the opinion that isn’t the way to go about it. In an article on his website, Dr. Mirkin cites several studies that contradict his earlier recommendations, including the following:

  • “The National Athletics Trainers Association found that ice was an over-simplified method and NOT effective at speeding up the healing process for a sprained ankle…It also recommends that you skip compression, which had no real impact on recovery….the study found that exercise helped to maintain blood flow and flexibility to the injured ankle, both of which are proven to speed up recovery.”
  • The Journal of Athletic Training published a study that found “when muscle tissues cool from icing the skin, blood vessels constrict and shut off the blood flow that brings in healing cells…After the ice is removed, the blood may then return, but the blood vessels may not open for many hours after the ice application…this research team found that this can cause the tissue to die due to lack of blood flow. It can also lead to temporary or permanent nerve damage and disability in the individual or athlete.
  • The Journal of Strength and Conditioning Research found that “tissue that is damaged through trauma or vigorous exercise requires inflammation…When muscles and other tissues are damaged, your body sends inflammatory cells to the damaged tissue to promote healing.”

The point of all this is that conventional wisdom no longer seems so conventional. So what do you do for a sprained ankle, and how can Pekoe help you with this?

The first step is to let the swelling and inflammation happen. Yes, it’s painful, and yes it looks ugly, but this is part of the healing process. Its okay to use ice shortly after the injury, as ice can help numb pain, but only use it for a short period of time (no more than twenty minutes.) Do not sit around with a bag of ice on your ankle all day. That won’t do you any good, and could actually hurt you. Your doctor will probably recommend you do some light movement to help with strength and rehabilitation, and you should definitely do what he says.

Second, come see us. We can use acupuncture treatment to increase blood flow and help with inflammation (which is actually good for you and promotes healing.) We can also help move the process along with Chinese herbs and massage treatments.

We really hope that you don’t sprain your ankle. It hurts and it’s inconvenient. But we want you to heal as quickly as possible, and it looks like RICE isn’t the way to go about it.