22/02/2024
In 1978, the concept of RICE- Rest, Ice, compression, elevation – for the treatment of acute athletic injuries was introduced in The Sports Medicine Book, authorized by Dr. Gabe Mirkin. Coaches have used the RICE guidelines for decades, and continue to implement these recovery methods within fitness and medical domains for acute musculoskeletal injury management. However, even though ice and absolute rest have been a standard treatment for injuries and sore muscles caused by injured tissue. In 2014, Dr. Mirkin went on record debunking his own work pertaining to the ice and rest portion of the RICE acronym for the purposes mentioned previously.
Icing a specific area when you damage tissue through trauma or develop muscle soreness by exercising very intensely disrupts the overall inflammatory process, lowering both inflammatory and anti-inflammatory cytokines. This application of ice to the injured tissue causes blood vessels near the injury to constrict and shut off the blood flow that brings in these healing cells of inflammation. For example, icing muscles after a sprint workout, for instance, reduced the levels of IGF-1 (an anabolic marker that usually increases after injury/exercise and improves healing/recovery), IL-1ra (an anti-inflammatory cytokine), and IL-1β (an inflammatory cytokine) while increasing levels of IGFBP-1 (a catabolic marker that breaks down tissue). Those are just markers, though, and an ankle sprain is not a sprint workout, however the responses to exercise and injury are based on the same inflammatory and anti-inflammatory mediators. As for lymph flow, it’s been shown that prolonged application of ice to tissue enhances the lymphatic vessels’ permeability, causing “backflow” of waste fluid back into the injured area, worsening edema, and potentially extending healing time.
In a recent study, athletes were told to exercise so intensely that they developed severe muscle damage that caused extensive muscle soreness. Although cooling delayed swelling, it did not hasten recovery from this muscle damage (The American Journal of Sports Medicine, June 2013). A summary of 22 scientific articles found almost no evidence that ice and compression hastened healing over the use of compression alone.
The authors of one study used two groups of mice, with one group genetically altered so they could not form the normally expected inflammatory response to injury. The other group was able to respond normally. The scientists then injected barium chloride into muscles to damage them. The muscles of the mice that could not form the expected immune response to injury did not heal, while mice with normal immunities healed quickly. The mice that healed had very large amounts of IGF-1 in their damaged muscles, while the mice that could not heal had almost no IGF-1. (Federation of American Societies for Experimental Biology, November 2010).
Ice is often used as short-term treatment to help injured athletes get back into a game. The cooling may help to decrease pain, but it interferes with the athlete’s strength, speed, endurance and coordination (Sports Med, Nov 28, 2011). In this review, a search of the medical literature found 35 studies on the effects of cooling. Most of the studies used cooling for more than 20 minutes, and most reported that immediately after cooling, there was a decrease in strength, speed, power and agility-based running. A short re-warming period returned the strength, speed and coordination. The authors recommend that if cooling is done at all to limit swelling, and since applying ice to an injury has been shown to reduce pain, it is acceptable to cool an injured part for short periods soon after the injury occurs. However, it should be done for less than five minutes, followed by progressive warming prior to returning to play.
