Author: Ruoxi Lin
Editors: Hwi-On Lee, Misha Wichita
Artist: Alvina Zheng
RICE: Rest, ice, compression, elevation. RICE is not only a popular food choice amongst all athletes, but also the recommended four-step protocol to follow while recovering from sprains, strains, and skeletal injuries. Originating in 1978 from Dr. Gabe Mirkin’s novel, The Sports Medicine Book, this procedure carries weight in the eyes of trainers and holds a special place in the hearts of trainees. However, in the past two decades, there has been a growing trend backed by scientists and doctors discouraging RICE due to the uncertainty of its effectiveness and suspicion that it instead delays recovery. As appalling as it sounds, these scientists and doctors may be right with some recent studies questioning this method and many that expose the detrimental effects of icing injuries.
One of the primary reasons for this trend of doubt is that there’s simply not enough proof. A 2012 review of studies concluded that there was a lack of significant evidence to account for how well RICE actually worked. Using databases such as MEDLINE and CENTRAL (Cochrane Clinical Trial Register), researchers identified all studies that utilized one of RICE’s components to treat an acute ankle sprain within 72 hours after trauma occurred. In their review, a random selection of 11 controlled clinical studies dated back to before 1990 and were of poor quality. In one study, there was no specific recommendation for different compression methods and another lacked a non-ice control group to compare the results of icing an injury. The basic conclusion they reached stated that some form of mobilization—such as exercise therapy—was beneficial in treating ankle sprains; going against the idea of resting for extended periods of time. Cryotherapy and ice application were thought to be helpful when used in short, intermittent periods, but due to limited findings and the effects of ice not being thoroughly studied, the claim remains unsupported. There is even less evidence to ascertain that elevation and compression influence recovery, since much of the evidence collected for those factors was anecdotal.
Furthermore, it has been proposed that the RICE method may hinder recovery—particularly because of the ice step. In an article published by the Advanced Physical Therapy Education Institute, Dr. Bahram Jam, a physical therapist, discusses the negative consequences of using ice for recovery. He highlights the process of acute inflammation that occurs after soft tissue injuries—a positive reaction—that while undoubtedly painful and restricting movement, signals to the brain to not injure the tissue further. Inflammation promotes blood flow to the injured area, allowing for white blood cells such as macrophages to release the hormone IGF-1 to stimulate healing. Icing the injury both interferes with healing by preventing the release of IGF-1 and hinders the natural lymphatic system processes that drain waste products and fluid buildup after inflammation as well. Dr. Jam brings up a 2011 study examining the effects of icing rat muscle injuries; the group receiving the ice treatment had smaller and fewer regenerating muscle cells, significantly less regenerating muscle fibers later on as the rats recovered, and abnormal collagen formation. The no-ice group’s recovery progressed normally, leading the researchers to conclude that it may be better to avoid icing, as it can interrupt and slow down the healing process.
Despite being an overwhelmingly accepted practice in the sports world, the RICE procedure is not advisable due to its lack of evidence and the harmful implications of using ice to soothe an injury. The creator of RICE, Dr. Gabe Mirkin, has also retracted his advice in a 2015 article on his fitness website as well as even going on to provide evidence that prolonged icing could reduce an athlete’s speed, strength, and endurance. Since then, medical professionals have started looking for better alternatives to replace the outdated method, such as MEAT (Movement, Exercise, Analgesia, Treatment), which utilizes moderate movement to speed up recovery from mild injuries, decreases the likelihood for scar buildup, and improves blood flow and joint function. All in all, these unfavorable results from studies on RICE provide valuable insight into better courses of action to take when dealing with injury.
Citations:
Academy, U. S. Sports. “The R.I.C.E Protocol Is a MYTH: A Review and
Recommendations.” The Sport Journal, 30 Oct. 2020, thesportjournal.org/article/the-r-i-c-
Jam, Bahram. “Questioning the Use of ICE given Inflammation Is a Perfectly Healthy
Response Following Acute Musculoskeletal Injuries.” Advanced Physical Therapy
Education Institute, 20 May 2014.
“Rest, Ice, Compression, and Elevation (RICE): Method and How It Works.”
Www.medicalnewstoday.com, 11 Apr. 2018,
Steven Smith. “RICE vs. MEAT: Which Is the Faster Recovery Method?” Tulsa Bone & Joint
Associates, 19 Sept. 2022, tulsaboneandjoint.com/about/news/rice-vs-meat-which-is-the-
Strickland, Heather . “Have a Little M.E.A.T. With Your R.I.C.E.” Www.aviatorhh.com, 26
van den Bekerom, Michel P.J., et al. “What Is the Evidence for Rest, Ice, Compression, and
Elevation Therapy in the Treatment of Ankle Sprains in Adults?” Journal of Athletic
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Wang, Zi-Ru, and Guo-Xin Ni. “Is It Time to Put Traditional Cold Therapy in Rehabilitation
of Soft-Tissue Injuries out to Pasture?” World Journal of Clinical Cases, vol. 9, no. 17, 16
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