How many of you are familiar with the acronym RICE? Standing for Rest, Ice, Compression, Elevation – This has been used in the athletic and therapy field for decades as an easy way to remember how to treat acute soft tissue injuries. Sprain and ankle? just RICE it. Twisting your knee? Just RICE it. Get punched in the face.. put a fat steak on it for some reason.
Well, as it turns out, this may not be the most effective way to manage a soft tissue injury. Let’s dive in.
In 1978 Dr. Mirkin coined the acronym RICE in his “Sports Medicine Book.” and it gained popularity with coaches and healthcare professionals as an easy way to combat inflammation. However, in the years since the publication a plethora or research has come out that disputes the method. In fact, in 2015 Dr. Mirkin recanted his position on the protocol. There are a few reasons why RICE is no longer advise, including:
Inflammation’s Role: While inflammation was traditionally viewed as solely detrimental, it’s now understood to be a crucial part of the body’s healing response. Inhibiting inflammation with ice and anti-inflammatory medications during the acute phase of injury may actually impede the body’s natural repair mechanisms.
Tissue Healing Dynamics: Recent studies have shed light on the dynamic nature of tissue healing. Rather than simply focusing on reducing swelling and pain, modern approaches prioritize creating an optimal environment for tissue repair and regeneration. This involves promoting circulation, minimizing further damage, and facilitating controlled movement to stimulate tissue remodeling.
Negative Effects of Ice: Contrary to previous beliefs, ice therapy (cryotherapy) has been found to potentially delay recovery by constricting blood vessels and reducing blood flow to the injured area. While ice can temporarily numb pain, its impact on long-term healing and tissue quality is now under scrutiny.
That all brings us to an updated, more evidence based approach to treating soft tissue injuries. PEACE & LOVE.
In the immediate care of an injury (first 48-72) hours we want to follow PEACE
Protect:
Shield the injured area from further harm. This may involve immobilization or bracing to prevent exacerbation of the injury.
Elevate:
Raise the injured limb above heart level to reduce swelling and promote drainage of excess fluid.
Avoid Anti-inflammatory Meds:
Contrary to previous recommendations, recent studies suggest that anti-inflammatory medications may hinder the body’s natural healing processes during the acute phase of injury. It’s advisable to steer clear of NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) like ibuprofen and aspirin during this initial period.
Compress:
Apply gentle compression to the injured area using bandages or wraps. This helps minimize swelling and provides support to the affected tissue.
Education:
Empower the individual with knowledge about their injury and appropriate self-care strategies. Understanding the nature of the injury, expected recovery timeline, and warning signs of complications can aid in effective management and rehabilitation.
Once we’ve dealt with the initial injury, then we need to give the affected tissue some LOVE (subsequent management)
Load:
Gradually reintroduce controlled movement and activity to the injured tissue. This progressive loading stimulates tissue remodeling and strengthens the affected area.
Optimize:
Focus on optimizing biomechanics and movement patterns to prevent re-injury. This may involve corrective exercises, posture training, or ergonomic modifications tailored to individual needs.
Vascularization:
Promote blood flow to the injured area through targeted exercises and modalities such as massage, heat therapy, or low-intensity aerobic activity. Enhanced circulation aids in nutrient delivery and waste removal, fostering tissue repair and regeneration.
Exercise:
Engage in a structured rehabilitation program encompassing a variety of exercises to restore strength, flexibility, and proprioception. Progressive, functional movements help rebuild tissue integrity and restore functional capacity, enabling a safe return to pre-injury activities.
By embracing the principles of PEACE & LOVE, we can optimize the management of soft tissue injuries, promoting efficient healing and minimizing the risk of long-term complications. Remember, while RICE served as a cornerstone in injury management, evolving evidence reminds us to adapt our approach to reflect the latest advancements in sports medicine and rehabilitation. Let’s prioritize evidence-based care to ensure the best outcomes for those recovering from soft tissue injuries.
References:
Crystal, N.J., Townson, D.H., Cook, S.B. & LaRoche, D.P. (2013). Effect of cryotherapy on muscle recovery and inflammation following a bout of damaging exercise. European Journal of Applied Physiology, 113, 2577–2586
Dubois, B., & Esculier, J. (2020). Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine, 54, 72-73.
Scialoia, D., & Swartzendruber, A. J. (2020, October 30). The R.I.C.E Protocol is a MYTH: A Review and Recommendations. The Sports Journal.
Stovitz, S. D., & Johnson, R. J. (2003). NSAIDs and musculoskeletal treatment: What is the clinical evidence? The Physician and Sportsmedicine, 31(1), 35-52
Tseng, C., Lee, J.P., Tsai, Y.S., Lee, S.D., Kao, C.L., Liu, T.C., Lai, C. & Kuo, C.H. (2013). Topical cooling (Icing) delays recovery from eccentric exercise- induced muscle damage. Journal of Strength & Conditioning Research, 27(5), 1354- 1361
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