STOP USING ICE! Why the R.I.C.E Method is Making your Injury Worse!

For many years, athletes have been conditioned to think that when you happen to pick up an injury from playing a sport, the first thing you should do is to get an ice pack and place it on the area of injury.

Your parents, your coaches, hell, maybe even doctors have advised that you apply the R.I.C.E method (Rest, Ice, Compress, Elevate) on the area of pain to 'decrease pain and inflammation.'

Ice has become such a norm and custom for treating sports injuries, that many people don't even think twice about whether they should ice something or not. They think that just because everybody else is doing it to treat their injuries, they should do it as well.

However, the R.I.C.E method actually delays the healing and recovery process.

Dr. Gabe Mirkin, who originally came up with and wrote about the R.I.C.E treatment method in his best-selling Sportsmedicine Book in 1978, actually wrote a blog post on his website pulling back on his claim that ice is a complementary treatment method for sports injuries. He writes in his blog post,

"Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping." - Dr. Mirkin (Why Ice Delays Recovery, September 16th, 2015)

In this blog post, you will learn why the R.I.C.E protocol isn't the best treatment for your injury, how ice interferes with the healing process, how your body reacts to an injury, and tips on how to treat an injury so that you can recover quicker and get back to action.

Inflammation Is Essential

When you pick up a sports injury, such as a torn ligament or a strained muscle, your body immediately responds with a physiological response that acts towards healing and recovering that damaged muscle tissue.

When your body picks up a disturbance in the muscle tissue, it immediately starts the process of inflammation, however, many people misunderstand the importance of inflammation and why it is needed in the recovery process.

Inflammation is the first of three phases of the healing process for damaged tissue. Unlike what most people perceive it to be, inflammation is not an unwanted thing, but rather your body's natural defense mechanism to deal with unwanted bacteria, or in this case, muscle damage by sending essential chemicals to set the foundation for healing to take place.

In response to the physical trauma, your immune system sends white blood cells and macrophages to the area of the injury in order for them to interact with the damaged muscle tissue, activate hormones and internal processes that boost the healing procedure, and repair the area of injury. This is the inflammatory process, and it basically acts as the foundation for the other two stages of healing, which are repair, and remodeling.

Inflammation is essential for the healing process, without it, your body will not be able to enter the next two stages of healing.

Studies on the inflammatory process on a group of mice demonstrated the importance of the inflammatory process when healing a musculoskeletal injury. In the study, one group of mice were genetically altered so that they would not be able to carry out the inflammatory process, while the other group, which was the control, was able to carry out the process of inflammation normally.

Both groups of mice were exposed to 100 milliliters of Barium Chloride which was injected into their right quadricep. This was to induce damage in the muscle tissue to examine the effect of the inflammatory process.

The group of mice who weren't able to carry out the process of inflammation failed to enter the stage of healing that would repair and remodel the muscle tissue, since there was an absence of IGF-1, (insulin-growth-factor) which is a hormone produced by the macrophages sent to the area of injury in order to prepare the damaged tissue for repair. Because of this lack of inflammation in the muscle tissue, the genetically altered group of mice was unsuccessfully able to recover from the damage in their quadricep muscle.

However, the control group, which was able to carry out the inflammatory process, saw an abundance in the IGF-1 hormone and macrophage levels, and were able to successfully recover from the injury in their quadricep.

As seen from the experiment, the inflammatory process is an essential part of the recovery and healing process for injuries in the muscle tissue, and without it, our bodies can't shift the injured area into the repair stage of healing.

So stop fearing inflammation, because it is essential for you to recover quicker from this setback and get back to ripping it out on the field!

Inflammation Vs. Swelling

The misconception people have about inflammation, is that it is directly related to swelling, and although the two are related, they are two completely different things with completely different functions.

Inflammation is what we want, since it is the process in which your body reacts to a trauma and sends essential cells that initiate the healing process in the damaged area. Swelling is the unwanted result of inflammation. Swelling is the 'waste' products from the inflammatory process, and must be evacuated from the area of the injury.

These excess fluids produced from the inflammatory process build up in the area of injury, and must be cleared to avoid any interferences and to boost the recovery process so that the body can shift into the second stage of healing.

The way your body handles this evacuation of the excess liquids in the area of the injury is by utilizing the lymphatic system, which is the system that gets rid of all the waste in your body through sweat, urine, etc. The excess fluids from the inflammatory process are evacuated through the lymphatic capillaries when triggered by contractions in the muscle tissue which allow the lymphatic system to successfully pump out the fluid through it's system and drain the area of injury.

How Ice Stops the Recovery Process

Since inflammation is the first stage of the healing process, it is essential to prepare the damaged area for the repair and remodeling process. Therefore, anything that halts or delays the inflammatory process is restricting the body from being able to send the necessary blood cells and macrophages needed to the trauma to kickstart recovery.

When most feel a strain or experience some sort of pain, they feel inclined to immediately slap some ice on the area of pain because they have been conditioned to think that 'reducing inflammation' is the quick fire way to recover from an injury. However, by applying ice to the area of trauma, you are stopping your body from starting it's natural process of self-regeneration!

Exposing ice, or any sort of cold remedy to your muscles interfere with the physiological process of healing by acting as a vasoconstrictor, or in simpler terms, the catalyst for the narrowing of your vessels. The narrowing of these blood vessels causes local blood flow to the area of injury to be slowed down, which causes the rate of essential inflammatory chemicals and components, like white blood cells, macrophages, histamine, etc. to be delivered to the area of damage.

A study observing the effect of ice on muscular regeneration on mice, showed that the muscular regeneration of the 'icing' group was significantly slower than the regeneration of the 'no-icing' group.

"At 28 days after the injury, the cross-sectional area in the nonicing group was 64.5% above that in the icing group (Fig. 3B). At 28 days after the injury, the area in the nonicing group was significantly larger than that in the icing group (P  0.01)."

The 'non-icing' group had recovered a lot more efficiently than the 'icing group,' and the size of the muscle and tissue was much larger and stronger than the 'icing' group 28-days post injury.

Results from the experiment also showed that the 'icing' group lacked several of the inflammatory chemicals essential to the regeneration of the muscle compared to the 'non-icing' group.

Distribution of macrophages. At 12 h after the crush injury, in the nonicing group, several ED1 macrophages were demonstrated in the degenerating areas near the crushed site, and some macrophages were found within the necrotic muscle fibers (Fig. 4a). In contrast, in the icing group, although some macrophages were found in the degenerating area, macrophages invading the necrotic muscle fibers were not yet noted (Fig. 4b)

According to the results of the study, the total number of macrophages, which are one of the essential chemicals that are sent to the area of damage by your body, was a lot more abundant in the group without ice 12 hours after the injury, than the group who applied ice to the injury.

Macrophages are essential because they are the cells that consume and digest the damaged muscle tissue, as well as being the catalyst for activating several muscle-regenerating hormones such as growth hormone and IGF-1. By applying ice to an area of injury, you are restricting your body from being able to send these necessary cells to treat the injury.

What about swelling? Surely ice helps deal with swelling right?

Don't Rest an Injury!

Unfortunately, R.I.C.E does the opposite. Remember that swelling is the build up of waste from the inflammatory process, and must be evacuated from the area of injury through our lymphatic system.

However, the R.I.C.E protocol that many athletes were told to follow for acute sports injuries actually has no effect on the decrease of swelling!

This is because in order for swelling to be evacuated from the area of the injury, it must be manually moved through the lymphatic capillaries in our body. See, our lymphatic system isn't like our circulatory system, where blood is actively flowing through the pumping of our heart. The lymphatic system has no core that influences the flow of waste throughout our body, it is completely passive.

Thus in order for the lymph, or the fluid that is lost by the blood and the inflammatory process, to be moved our of the area of the injury and be returned back into the circulatory system, it relies on muscular contractions and movement for the lymph to be pushed through the lymph vessels.

The problem with the R.I.C.E protocol is that it doesn't aid with movement of fluid through the lymph vessels at all!

Because the athlete is keeping the area of injury immobilized and applying ice to the injured area, the lymph vessels also end up getting constricted, and the lack of contractions cause the fluid to build up instead of being evacuated!

So even though you think that applying that bag of ice on the area of pain is helping, it's actually worsening the swelling and decreasing what we actually need, which is inflammation!

So What Should You Do When Injured?

When injured, you should avoid 'resting' and 'icing' the injury like you've been told throughout your life.

If you're really looking to speed up the recovery process and get back to the field as quickly as possible, then replace ice, with MOVEMENT!

Although exercising and moving an injured area seems like the last you want to do, it is actually essential to promote the healing process! This is because by moving and performing pain-free exercises, we are promoting the evacuation of the excess fluid in the injured area, as well as promoting local blood flow which increases the rate at which your body is able to send helpful cells and chemicals to induce inflammation!

This doesn't mean to go all out and to immediately start aggressively training and loading the area of the injury, since this can cause further damage to the muscle tissue.

Instead, focus on moving your body by doing things such as going on walks, or bike rides, and performing pain-free rehab exercises that bring movement and contractions to the injured area.

By moving your body and performing pain-free exercises, you are promoting the evacuation of swelling through your lymphatic vessels and allowing your body to deliver more essential macrophages and white blood cells to the area of the injury to help restore and rebuild your damaged tissue to initiate repair and remodeling.

Another method to help promote the recovery process is HEAT!

Heat promotes blood flow throughout the body, which again, can help deliver essential macrophages and white blood cells to the injured area.

Not only is heat a lot more helpful than ice, it's also a lot less painful to use! 😁

You can apply heat to an injured area by simply using a heat pad (click on the link for the one I personally use), or by taking a nice, warm bath for 20 minutes (my personal favorite thing to do on my recovery days...)

Takeaway

For many decades, many athletes have been told to use the R.I.C.E protocol to 'reduce inflammation and swelling,' and to promote the recovery process.

Because of this notion that Resting, Icing, and Elevating an area is the go-to treatment method for sports injuries, many athletes are delaying the recovery process and spending more times on the sidelines than they should!

When we injure a muscle or ligament, our bodies immediately react by kickstarting the inflammatory process, which is the first of three stages in the healing process.

Many people fear inflammation because of the misunderstanding that more inflammation, leads to more pain, which means the area is not getting healed.

However this is very far off from the truth. Inflammation is simply your body's natural defense mechanism where it sends chemicals and cells to the injured/infected area in order to clear out damaged tissue, and release hormones that initiate the muscle regeneration process!

Without it, your body will not be able to enter the two stages of repair, and remodeling, which means that the injured area will fail to heal.

So stop Icing your injured/painful muscles! Ice restricts blood flow by narrowing blood cells and causing the rate at which your body delivers macrophages and white blood cells to be slower!

People also have a big misconception that ice and rest help lower the swelling in our bodies, however, the R.I.C.E protocol does the opposite!

Swelling can only be evacuated through our lymphatic system, which relies on MOVEMENT and muscular contractions in order to move the excess fluid and lymph away from our injured area and back into our circulatory system!

Your body is designed to be able to deal with injuries and to heal any damages sustained through sports. Doing the R.I.C.E method will just delay the healing process and cause you to spend more time on the sidelines instead of on the field.

If you're injured, stay away from icing your injuries and immobilizing the area, and instead, focus on performing pain-free movement and exercises to promote the evacuation of swelling, and promote the flow of essential inflammatory chemicals into the injured area!

Thanks for Reading! Alex from GoGrind Soccer signing off...

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