Should You Ice That Injury? Probably Not. (Or, Why RICE is Outdated and Wrong)

“Nothing burns like the cold.” ~George R.R. Martin, A Game of Thrones

As a competitive athlete in the 90s and early 2000s, I spent many a day getting cozy with a bag of ice.

The gold standard of care for any minor injury at that time — from a bruise to slight sprain — was, of course, to wrap the sucker in ice and wait.

When I got to college (where I was a member of the soccer team) we graduated from bags of ice to an actual ice bath, in which we would sit up to our waists after every game and almost every practice, not-so-secretly competing to see who could last the longest.

We also spent many an afternoon walking across campus with bags of ice plastic-wrapped around our thighs and knees and occasionally a shoulder, sincerely believing that this would aid our bodies in recovering more quickly from the day’s workout.

And no one — not even the athletic trainers — ever questioned the validity of this approach.

It was only when I started graduate school in Chinese medicine several years later that I was forced to reconsider the notion that ice should be the number one answer to any and all injuries, as well as the best way to stave off delayed onset muscle soreness (or, DOMS) and improve performance the following day.

From a Chinese medicine point of view, the way to promote healing and restore proper function to an injured area is to encourage circulation of Blood and Qi. Applying cold has the opposite effect, essentially slowing the flow of both Blood and Qi through the affected area and delaying the body’s healing response as a result.

Not good. For this reason, Chinese medicine generally advises against the application of cold for treatment in the majority of musculoskeletal injuries and for post-workout recovery.

When you think about it, this makes a lot of sense. Even from a biomedical perspective.

After all, cold temperatures do, in fact, slow down the circulation of blood and, by extension, reduce immune activity in the area being exposed to the cold.

This is a recipe for delayed and inadequate healing.

Furthermore, icing an area reduces nerve conduction in that area. Which absolutely can decrease your experience of pain, but isn’t so great for performance or preventing further injury.

Lastly, your lymphatic system — which is responsible for cleaning up a lot of the mess (i.e. cellular waste, damaged tissue) resulting from an injury — is a lot less effective when it’s cold.

The idea that icing a swollen area helps to reduce the swelling? Totally fictional.

If anything, ice is going to make swelling worse because it slows down the functioning of the lymph vessels responsible for getting rid of the excess fluid.

So then why does swelling appear to go down when you follow that old school favorite the RICE (Rest, Ice, Compression, Elevation) protocol?

Because compression and elevation actually DO encourage lymphatic flow. And, frankly, if you took the ice out of the equation, they’d probably do an even better job of reducing all that swelling.

In other news, did you know that the man responsible for coining the term RICE in 1978 for treatment of athletic injuries, Dr Gabe Mirkin, has come out publicly to say he was wrong?

Yep. It’s true.

In September of 2015, Dr. Mirkin posted a retraction on his website that included the following statement:

“Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.”

He has also recently said that, “About all icing is good for is a placebo effect.”

Whaaaat? If the man who essentially made ice the go-to treatment for all things musculoskeletal has changed his mind so dramatically, perhaps it’s time we reevaluate our inclination to immediately run to the freezer anytime anything is injured or painful.

I am not suggesting that there is never a time when ice isn’t an appropriate part of a treatment protocol. Especially in emergency situations, or in cases where controlling pain is primary.

But I am suggesting we maybe pause for a minute — especially those of us who are healthcare practitioners and athletic trainers/coaches — and ask ourselves what our ultimate goal is going forward.

For patients and clients who are looking to heal properly and enhance performance over the long-term, ice might be counterproductive to their goals and should be avoided the majority of the time.

For those who are more interested in being comfortable and reducing pain, ice could be considered. I still think, however, that patients should know the ice itself is merely serving as an analgesic and might actually slow recovery.

That way, it’s up to the individual to decide where his or her priorities lie.

One last thing…

Too much rest following an injury is also detrimental to the healing process.

While your circulatory system relies on the pumping action of the heart to move blood efficiently around your body, your lymphatic system has no such pump to assist it. Instead, your lymphatic vessels rely on the contraction of skeletal muscles to help shuttle fluid away from an injured area.

This is just one reason — among many — to begin some sort of rehabilitative exercise as soon as possible following an injury.

It’s also why an active cool down — i.e. walking, a slow jog, an easy bike ride — is a significantly better way to recover post-workout than a giant tub of ice.

For more on this topic, check out this video, in which Dr. Kelly Starrett and trainer Gary Reinl discuss in more detail why icing is not so great for healing athletic injuries.

And here’s a selection of other articles on the topic I recommend checking out:

A Recovery Ice Bath Isn’t (Always) Such a Good Idea

Why Ice Doesn’t Help An Injury

Paradigm Shifts:  Use of Ice and NSAIDS Post Acute Soft Tissue Injuries

Ice is Not the Answer For Recovery

10 Reasons Icing Injuries is Wrong

Why Ice and Anti-Inflammatory Medication is Not the Answer

 

As always, questions, comments, and feedback are welcome. My goal with this article is not to have everyone everywhere toss out their freezers tomorrow. My hope is to encourage us all to think a bit more critically, to ask more questions, and to not blindly adhere to a protocol for injuries that could be doing more harm than good.

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