A friend injured her wrist recently and I immediately quoted, “R.I.C.E.” It was what I was taught – years and years ago, I might add. I’m afraid that I’ve never looked it up since. Thankfully, it was a comment I made on a group chat and someone else who was up to date, corrected me.
Standard healthcare practices and regimes do change. With our growing knowledge and understanding of the human body, the things we used to hold true may no longer be pertinent. I mean, this is why healthcare practitioners are required to attend continuing education courses. The same applies to us – life is just one long continuous learning experience.
Always be open to learning and keep yourself updated – especially with information you’ve held on to for eons. So this is me updating my information.
Why Not R.I.C.E.?
Just in case you aren’t familiar with this acronym, R.I.C.E. stands for rest, ice, compression, elevation. Not that you need to remember it since it’s no longer relevant. Now that you know what it is, you can promptly forget it. Or you can remember to tell anyone who quotes it to you that it’s outdated information.
Before you forget it, though, let’s look at why “not R.I.C.E.” Dr Jennifer Robinson has written a pretty detailed account on this, but here’s the short of the long:
- On Rest: Recovery after an injury (as long as it isn’t a fracture or a catastrophic injury) is improved with movement, not rest. This is because movement improves blood flow, which brings oxygen to the site of injury and helps to remove metabolic waste. Movement also triggers the release of chemical growth factors that lead to the maintenance, repair, and strengthening of bone, cartilage, tendon, and muscle.
- On Ice: Ice delays recovery because it causes vasoconstriction, which reduces blood flow to the site of injury and inhibits the inflammatory response – both of which are required for healing to occur.
- On Compression and Elevation: The evidence on both are scant. It is suspected that the benefit is a placebo. If you think it helps, it will help you. If you doubt it, it is less likely to produce any benefit. Although, logically speaking, elevation pits gravity against blood flow which is contrary to what we want for healing.
According to the Journal of Athletic Medicine Research, icing kills muscle cells.
A report from the Journal of Strength and Conditioning Research revealed that not only does icing fail to help injuries heal, it may well delay recovery from injury.
The University of Pittsburgh Medical Center found evidence that icing sore muscles may be detrimental to recovery.
From researchers at the Cleveland Clinic: Icing an injury delays the release of IGF-1 (insulin-like growth factor-1), a key hormone unleashed by immune cells to repair damaged tissues.Jim Thornton, Spartan Training
R.I.C.E. doesn’t mention the use of anti-inflammatories but this is also a popular go-to treatment protocol. Of these, there is no evidence that shows the benefit of taking NSAIDs (non-steroidal anti-inflammatories). Steroidal anti-inflammatories, such as cortisone, have been found to inhibit the production of collagen and granulation tissue which opposes healing.
If not R.I.C.E. then what?
- Options for cross training.
- Vary rehabilitation with strength, balance, agility exercises.
- Easing back to activity early.
So long as it is not a fracture or traumatic injury.
- foot and ankle injuries – drawing the alphabet with the toes.
- knees – stationary biking with low tension.
- shoulder injuries – pendulums, pole walking, and Nordic ski.
- neck pain – rows and ellipse.
- back pain – walking, swimming, and yoga.
- lower limb fractures – water running and seated weights.
- upper limb fractures – walking and the recumbent bike.
Connecting Theory with Experience
All of this has got me thinking back on a few past experiences with injuries and how they tie in with these findings. Top of mind was my right ankle that has sustained more sprains than I can remember.
My earliest memory of a rolled ankle was in Primary School. When it happened, a friend helped me rehabilitate it by rotating my foot clockwise and counter-clockwise around the ankle. Back then, I didn’t know about R.I.C.E. so I didn’t ice it, I didn’t compress it, and I certainly didn’t rest it. You could say I was young and that kids take injuries in stride. Or maybe it wasn’t as bad as I remembered. Perhaps.
When I was in Uni, I sprained my ankle pretty badly while I was running after the bus. I iced it, medicated it, rested it and elevated it, but it took forever to heal. You could also say that I was older and that the injury was worse than the one I sustained as a child. Perhaps.
Three days before my very first Spartan race, I rolled my ankle while I was rushing to pick up the kids from school.
My first panicked thought was, “Oh no! Please tell me I can still race!”
My second determined thought was, “I’ll be damned if I let this ankle stop me from racing!”
I remembered what my friend did for me all those years ago in Primary School and decided I was going to try gentle mobility exercises. Whenever I could, I would rotate my foot around the ankle – clockwise, then counterclockwise. I didn’t ice it and I didn’t rest it – mostly because I didn’t want anyone to know I’d injured it. I knew I would get told off, and possibly talked out of, racing on a bad ankle. In my mind, I willed my ankle to feel better. By race day, it felt good as new.
My right ankle has always been a problematic joint for me. It twists easily when I least expect it and it can happen when I’m wearing flat shoes walking on level ground. A sports physician who examined it years ago noticed that the ligaments supporting the joint is loose. Probably because it never healed properly after a particularly bad sprain (I’m thinking it was the incident with the bus).
I digress… these were my most notable ankle injuries that tie in with the new M.O.V.E. protocol.
The Knee Under Compression
Moving away from ankles, let’s talk about the knee. When I was a rock climber, I sustained a bad knee injury from a leader fall. I pendulum-ed into a protruding stalactite and hit my left knee hard. I didn’t break anything (so maybe it was not that bad) but I wasn’t able to walk properly or step on the clutch to change gears in my car. I was off rock climbing for a month.
I thought I shouldn’t climb again until the pain went away. Except the pain didn’t go away. It felt better when I wore a knee brace so I thought I needed the compression to heal faster. I started wearing the knee brace more often and for longer periods. Instead of improving, the knee pain got worse. My knee would feel good when the brace was on, but the moment I took it off, the pain would come flooding back. It occurred to me then that too much compression was actually bad.
In the end, about a month after the injury, I got impatient waiting for my knee to “heal”. I decided to return to some gentle climbing. I kept the pressure light on the left leg and climbed mostly with my arms and right leg. Over time, I gradually increased the pressure on the left leg as my knee began to feel stronger. I could feel discomfort during climbing, but it wasn’t pain.
While I can’t really speak about the healing process that was going on in my knee, it wasn’t getting better with “rest” or “compression”. It was movement and exercise that eventually brought my knee back to full function.
Don’t R.I.C.E. Just M.O.V.E.
So there… based on the injuries that I can recall, R.I.C.E. did not speed up my recovery, but M.O.V.E. did. So I guess I know what I’ll be doing in future if I sustain another injury (barring a fracture or a catastrophic injury).