Back in 1978, Dr. Gabe Mirkin created the protocol of R.I.C.E for the management of soft-tissue injuries. This became the “gospel” for the next several decades, as coaches, athletic trainers and clinicians all found themselves reciting this quip to patients in order to help aide in the recovery process.
Except, it doesn’t…
So much so that the originator of the entire concept. Dr. Mirkin, recanted his original views on the topic and had this to say, “
"Coaches have used my 'RICE' guideline for decades, but now it appears that both ice and complete Rest may delay healing, instead of helping. In a recent study, athletes were told to exercise so intensely that they developed severe muscle damage that caused extensive muscle soreness. Although cooling delayed swelling, it did not hasten recovery from this muscle damage."
(Dr. Mirkin in 2014)
Let’s break it down a little further…
We know that resting, or literally doing nothing, has not been shown to improve outcomes in soft-tissue injuries. In fact, the worst thing to do with back pain is to lay in bed rest. Conversely, MOVEMENT helps with circulation, lymphatic drainage and overall muscle function. By not moving, you are more likely to develop muscle atrophy (muscle shrinking). This atrophy is very difficult to overcome, as muscle is very metabolically demanding. It takes weeks or months to achieve muscle adaptations, but in as little as 24 hours to start to lose. By resting, you are expediting the muscle atrophy pathway and making life that much more difficult for you to return to running, working out, walking or something meaningful like playing with your kids.
Fun fact; it wasn;t until 1962 that we started icing out sore soft-tissues post-workout or competition. Up until that time frame, athletes stretched and recovered in a very different way. Here’s my take on why I do not recommend ice for athletes. Once an injury occurs, there is tissue damage in the area of the injury (typically). Tissue damage means dead cells and inflammatory markers. These inflammatory markers signal to the immune system to help clear any of the dead cells out of the area, hence why we get swelling in the area of the injury. If we don’t have the ability to clear the dead cells, how can tissues recover? Ice has been shown to help with the initial swelling, BUT what if we needed that initial swelling in order to clear the dead cells out of the area? If we ice too often, perhaps this could explain the constant soreness one feels in the immediate aftermath of icing.
Actually, I quite like the idea of compression. Let’s keep that going with some form of elastic compression as the ideal form of compression for athletic events and soft-tissue recovery.
It used to be believed that elevated the injury “above the heart” helped promote healing faster. Turns out that was also unsubstantiated. What does promote healing is progressive movement. When we contract skeletal muscle, our muscles act like an impressive compressive machine pushing lymphatic fluid and swelling back into the venous system. This requires movement not rest!
Stay tuned for Part 2 of our soft-tissue recovery series next week where we provide an alternative to the outdated RICE method (We won’t just bust myths without providing a solution. We aren’t the mainstream news media protecting corrupt politicians!).
Alex Earl, DC