RICE is Out, Now What?

If you haven’t heard RICE is old news. The RICE Method has been around since the 1970’s and it is widely understood way to address pain and swelling when you get injured. It was thought to also speed healing. Dr. Gabe Mirkin, a physician and author coined the term RICE in his book for athletes that published in 1978. Over 40 years later rest, ice, elevation, and compression, still appears to be the most common recommended treatment for sports or recreation related injuries amongst coaches, parent, and many healthcare providers, although that is changing. What I want to take about is the updated recommendations for managing acute injuries and why a change was necessary. 

There is no doubt the RICE Method, a simple self-care technique, has benefits. There has also been a growing conversation amongst health care providers that we should come up with something better.  In the more recent years in the medical community there is a broader appreciation for that inflammatory process. We know that just addressing the signs and symptoms of inflammation do not necessary speed healing or provider “best practices”. For example, research has shown that both rest and ice can delay healing.

Let me explain a little further. Every time you are sick or injured the body initiates the first phase of healing, the inflammatory cascade begins. There are five classic signs of inflammation which include:

  • Redness
  • Pain
  • Swelling
  • Warmth
  • Loss (decrease) of function

Common methods like icing and NSAIDs are affective in managing pain related to inflammation but can slow the healing process that is initiated through inflammation because of constriction of the blood vessels limiting circulation of the nutrient rich blood needed for repair.  Think of inflammation as the body’s first line of defense. As the repair process is occurring it is the job of our lymphatic system to naturally (although slowly) remove the waste and excess fluid that has builds up.  This process is assisted through compression and elevation, but more impacted by the movement of our skeletal muscle.

An experiment was done in 2011 entitled “Influence of Icing on Muscle Regeneration After Crush Injury to Skeletal Muscles in Rats” was new evidence to show the physiological changes when using ice following an injury, or not.  In this study they separated rats into two groups. One would receive ice for 20 minutes following a soft tissue injury and the other did not.  Researchers later microscopically analyzed the tissue at several points post injury from hours to days. What they found is that interrupting the natural inflammatory response was actually counterproductive to signs of healing in the tissues. Wow!

So what is the best method to recover faster? What do we do now? There have been a different suggested acronyms floating around. Here is a summary of my favorite:

  • The first one is POP
    • Protect
      • Initially it just makes sense to protect the injury
      • This is where a sling, brace or activity modification is helpful
      • Don’t forget to reach out for medical care if it appears to be serious
    • Optimally Load
      • This means choose your activity wisely but not typically complete rest
    • Pain Management
      • If protecting and modifying activity is not enough, you may add outside support
      • My favorite topical analgesics are Biofreeze, Tiger Balm, Neptune Ice, Rock Sauce, and Deep Blue
      • Ice or heat
      • Kinesiology tape is a great tool for pain control and mobility
      • You may even have to take something for pain in the short term
  • Secondly there is MEAT
    • Movement
      • The goal is to move without exceeding pain tolerance
      • Even a slight load will assist the new tissue to regenerate in the proper way
      • Depending on the injury movement may be a walking routine or even just simple range of motion exercises
    • Exercise
      • As pain decreases activity increases
      • I usually discourage exercise until your pain is consistently under a 4/10
    • Analgesics
      • Lean on natural
      • Avoid making NSAIDs your first choice whenever possible since evidence shows they also slow healing
    • Treatment
      • Seek the assistance of a health care professional
      • It is important to rehabilitate the injured area to minimize risk of recurrence and the effects of compensation in other areas

I like both POP and MEAT.  They get the point across and are easy to remember. They both also touch on the fact that if there is pain you have options of how to approach it, even if that is temporarily using ice. I often suggest alternating heat and ice to get some of the natural analgesic effects of ice and the pumping action it creates to bring in fresh blood and pump out waste products. Consider 2 rounds of each starting and ending with heat. 10-20 minutes of each. Be sure to protect your skin and listen to your body.

In my practice I also commonly recommend well researched and effective enzymes, botanicals, herbals, food nutrients over the years such as:

  • Arnica
  • CBD
  • Bomelain
  • Turmeric (and its active ingredient curcumin)
  • Boswellia
  • Tart Cherry
  • Magnesium

You can find high quality supplements at the office or in my online dispensary on Fullscript.com. 

Of course I hope you are free from injury for a long while, but the next time your adventures get you down, skip the RICE and try a new approach! If you are seeking help for an injury illness or the wellness way of living contact us at (314) 833-4600.

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