Is It Time to Take the Ice out of RICE?

You’ve probably heard of RICE — not the food, but the acronym for a common treatment protocol: Rest, Ice, Compression, Elevation. If you’ve ever had an athletic injury or even just sore muscles, someone has probably given you that advice.

“RICE it,” they say, and they’ve been saying it for years — ever since the 1978 publication of Dr. Gabe Mirkin’s Sportsmedicine Book.

The trouble is that advice is wrong, at least according to Dr. Mirkin himself, who no longer recommends RICE. More specifically, it’s the rest and the ice that evidence now shows to be counterproductive, not only not helping an injury but actually delaying recovery time.

The RICE protocol was designed around the idea that inflammation should be reduced, and ice is great at that. But inflammation happens when the body sends an influx of healing cells to a damaged area; it’s the beginning of the healing process. Icing an injury delays the inflammation, but also delays the start of healing without providing any other benefits other than perhaps temporary pain relief. At least that’s the consensus emerging from a number of studies, including reports in the Journal of Strength and Conditioning Research; a meta-analysis (of 22 separate studies) published in the British Journal of Sports Medicine; and research of the University of Pittsburgh Medical Center, among others.

There are still plenty of professionals who recommend icing to their patients. They may have anecdotal evidence or personal experience that shows them that icing works — and it is certainly an option for temporary pain relief — so it’s worth listening to what they have to say. But opponents of icing argue that it’s simply an old habit dying hard, and it’s time to move on to something new.

As for rest, the modern thinking here is that careful muscle activation prevents atrophy, clears lymphatic waste, and increases blood flow to damaged tissue.

“If the injury is severe, follow your doctor’s advice on rehabilitation,” says Dr. Mirkin. “With minor injuries, you can usually begin rehabilitation the next day. You can move and use the injured part as long as the movement does not increase the pain and discomfort. Get back to your activity as soon as you can do so without pain.”