To Ice or Not to Ice? The Age Old Question

    You sprain your ankle out on a hike with your family. Your first thought and the advice people will give you will likely be the RICE (rest, ice, compress, elevate) method. This is the tried and true, salt of the earth, go-to treatment for any type of acute musculoskeletal injury. How did RICE become so well known, and is it as effective as we think it is? 

    RICE was developed by Dr. Gabe Mirkin in his 1978 book, The Sports Medicine Book and has gained popularity steadily ever since¹. Dr. Mirkin developed this treatment as a way of reducing inflammation with the goal of allowing you to return to activity as soon as possible. RICE does seem to reduce pain, inflammation, and swelling for those with acute injuries, but as we learn more about this modality, there is evidence to suggest that RICE may slow and potentially stunt the natural healing process₁. Dr. Mirkin has even changed his stance on RICE, instead favoring early movement after injury and limiting icing to a short period of time after an acute injury, less than 10 minutes at a time and within 6 hours of the injury¹

New studies have begun to show that RICE treatments can impede healing by inhibiting the release of growth factors, blunting the function of the immune system as well as blocking inflammation^2–4. Although RICE is effective at reducing pain temporarily, the method also reduces blood flow to the site. Adequate blood flow to the site of injury is vital to healing; blood brings oxygen, nutrients, vitamins, and minerals to the area of injury. Inhibiting this process can slow down and even stop the healing, compromising the integrity of the tissue. 

What can we do when we experience musculoskeletal injury? Our goal is to elicit a positive inflammatory response, stimulate the growth factors, and bring more nutrient-dense blood flow to the site of injury. The goal is to get you back to doing what you love as safely and as soon as possible, and to ensure that your healing is true and sustainable. Alternatives to RICE that are effective include: acupuncture, low-level laser, active rest, functional/therapeutic movements, and injection therapies^{5, 7, 8-10}. All of these therapies can help to improve the inflammatory response in a positive way. Through these methods, your sprained ankle/shoulder/wrist/etc will heal quickly and regain strength; allowing you the freedom you had before. 

1.        Why Ice Delays Recovery | Dr. Gabe Mirkin on Health. http://www.drmirkin.com/fitness/why-ice-delays-recovery.html. Accessed January 15, 2020.
2.        Collins NC. Is ice right? Does cryotherapy improve outcome for acute soft tissue injury? Emergency Medicine Journal. 2008;25(2):65-68. doi:10.1136/emj.2007.051664
3.        What Is the Evidence for Rest, Ice, Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396304/. Accessed January 15, 2020.
4.        Van den Bekerom MPJ, Struijs PAA, Blankevoort L, Welling L, van Welling CN, Kerkhoffs GMMJ. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? Journal of Athletic Training. 2012;47(4):435-443. doi:10.4085/1062-6050-47.4.14
5.        Yuan QL, Wang P, Liu L, et al. Acupuncture for musculoskeletal pain: A meta-analysis and meta-regression of sham-controlled randomized clinical trials. Scientific Reports. 2016;6. doi:10.1038/srep30675
6.        B Cotler H. The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain. MOJ Orthopedics & Rheumatology. 2015;2(5). doi:10.15406/mojor.2015.02.00068
7.        Bleakley CM, O’Connor SR, Tully MA, et al. Effect of accelerated rehabilitation on function after ankle sprain: Randomised controlled trial. BMJ (Online). 2010;340(7756):1122. doi:10.1136/bmj.c1964
8.       Middleton KK, Barro V, Muller B, Terada S, Fu FH. Evaluation of the effects of platelet-rich plasma (PRP) therapy involved in the healing of sports-related soft tissue injuries. The Iowa orthopaedic journal. 2012;32:150-163.
9.        Zhang JY, Fabricant PD, Ishmael CR, Wang JC, Petrigliano FA, Jones KJ. Utilization of Platelet-Rich Plasma for Musculoskeletal Injuries: An Analysis of Current Treatment Trends in the United States. Orthopaedic Journal of Sports Medicine. 2016;4(12). doi:10.1177/2325967116676241
10.     Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2016;9:139-159. doi:10.4137/CMAMD.S39160

Author

Dr. David Chang ND, LAc David Chang, ND, LAc, is a board-licensed naturopathic physician and acupuncturist with extensive training in Naturopathic primary care and classical Chinese medicine. With more than six years of professional experience and a strong interest in chronic pain management, he is proud to own and operate his practice in Portland, Oregon.