The R.I.C.E. method

Today I would like to talk about a discussion that has recently gained a lot of momentum and is concerned about first aid measures after a sports related injury. The R.I.C.E. method.

R.I.C.E. was originally published by Dr Gabe Mirkin in 1978 in ‘The Sportsmedicine Book’ and stands for Rest, Ice, Compression, Elevation. This rule was quickly established as the standard for sport injuries and accidents and stayed the go-to-method for several decades.
The aim of this method is to counter-act the swelling of injured tissue as fast and as soon as possible in order to avoid it or reduce it. This way it is (or rather, was) believed to reduce additional damages stemming from the swelling and pain. So far so good.

Doctors, physical therapists, coaches, and medical attendants have incorporated the R.I.C.E. method for decades. Of all persons, it was the inventor himself to criticize this method recently. He was certainly supported by several recent studies that have shown that cooling (partially strong cooling with ice) and elevation slow down the healing process.

The explanation: cooling and elevating the tissue constrict the blood vessels and pores. Less blood can be transported to the injured area. Unfortunately, this goes along with a reduced exchange of nutrients. However, when injured the body needs to inflame in order to heal itself. In order to inflame the body produces certain inflammation-markers. These markers are necessary temporarily but can slow down the regeneration process when they are present too long. And this is exactly what happens when cooling the injured tissue!

The next thing the body does is try to remove the damaged cells with the help of macrophages. Supplying enough of these scavenger cells, however, is difficult because of the reduced blood flow. Additionally, the macrophages send out a messenger called IGF-1 (a protein). This messenger is extremely important for the reconstruction process of cells and is lacking when the numbers of macrophages is reduced.

Another point that Mirkin makes is the possibility of damaging the nerves when cooling the damaged tissue continuously.

Mirkin has realized that there are more than enough reasons to make sure that the injured tissue is supplied with an adequate amount of nutrients and blood in order to assure the tissue can heal properly and as fast as possible. The R.I.C.E. method should at least be reviewed.

Thus, our recommendation is this: stop the activity, cool for 20 minutes at max, active regeneration, and later mobilization, NOT immobilization!

Your Fabien