The Fallacy of RICE

by Todd Howard

For more than a decade I have maintained the position – to patients and audiences – that the typical RICE prescription (Rest, Ice, Compression and Elevation) for physical injuries is not only counter-intuitive but also harmful to the healing process.

During my university studies, as both a varsity athlete and an Exercise Physiology student in the School of Medicine, I was exposed to RICE therapy, and in particular ice therapy, on a daily basis. I passed many hours during both times of health and of injury immersed from the thighs down in an acerbic stainless steel ice bath.

Often doubting some of the dogma of allopathic (Western) medicine, I began to explore the philosophies of holistic medicine. This led me to question many paradigms, not the least of which was the stalwart concept of RICE. I am pleased to see others are doing the same (see Why ice doesn’t help an Injury).

To understand the rise of RICE, one must first understand the mentality of the vast majority of people when it comes to health management. Simply put, health to most is the absence of symptoms. However, those who experience true vitality fully understand that this is a simply not the case. True health is much more than just the dearth of symptoms. And even further to the contrary, symptoms are actually an indication of a healthy body relaying messages when something is out of balance. Be it pain, inflammation, congestion, indigestion or a myriad of other possibilities, symptoms are akin to a car’s warning lights. You would not dismantle your warning lights because you were annoyed by being informed of low engine oil, so why would you go to lengths to quell your personal health symptoms?

Stifling symptoms rather than heeding their message is a harbinger of disaster as the practice buoys the quiet festering of complications. Inflammation is a natural healing response to physical trauma, and typically manifests with 5 main symptoms: pain, heat, redness, swelling, and decreased range of motion. Each symptom has a specific purpose and relays a message. Pain indicates damage has been done and mitigates the risk of more damage. Heat is a localized febrile response, redness is due to this heat and demonstrates increased blood flow to the area, and together they help to stave off potential infection. Swelling isolates the area of trauma to both prevent spread of infection and to enforce the safety afforded by decreased range of motion. Waging combat against any of these symptoms prevents the body from benefitting from the natural healing response.

RICE is a strategy that was developed as an antidote to the symptomatic manifestations of inflammation. Unfortunately, the antidote interferes with the exact result the body is trying to achieve: healing.

Perhaps the most pervasive of the RICE protocol, ice seems to be recommended for every type and phase of injury. Referring to the 5 symptoms of inflammation indicated above, ice will effectively reduce swelling by constricting vessels, subdue pain by scrambling nerve transmission, and decrease the heat of the localized fever. All told, the healing response suffers a tremendous setback. In my opinion, ice should never be used for an acute injury unless in an attempt to ward off potential shock by mitigating pain. I only utilize ice when an injury becomes more chronic and fluid exchange is being hampered by prolonged inflammation. There is no specific time after an injury when this occurs, but I recommend avoiding ice for at least the first 3 days post injury. And if and when I do finally employ ice, I follow immediately with heat and perhaps repeat a few times to engender the benefits of a thermal massage: constriction followed by dilation equates to the pumping of fluids.

Compression and elevation are other strategies that are in contradiction to the healing response. They reduce swelling and thus the influx of blood and healing fluids into and out of the injury site, and potentially reduce pain. As with ice, once an injury reaches the chronic stage, compression and elevation can be employed periodically to help reduce stagnation. Use in the initial stage of injury, however, has deleterious effects on healing.

Of the four tenets, the only one I can cautiously recommend is rest with the caveat that the lymphatic system will function less at rest and thus stagnation at the injury site will eventually occur. Once significant damage has been ruled out, gentle movement within the limits of normal range of motion will help to encourage the circulation of healing fluids and thus aid recovery.

So with RICE out, what can we do in the wake of physical trauma? Sticking with a food acronym, I suggest PASTA – Please Ask Someone To Assist. Someone can be one or many therapists, or in the absence of, a family member, friend or bystander.

Provided there is not an open wound, the first action I recommend as soon as possible after the injury is a very gentle and superficial massage in the direction of the heart. This helps bolster fluid circulation, and, if done using herbal oils or creams, can especially expedite the healing process.

Second, I suggest acupuncture as it greatly augments numerous components of healing such as improved circulation and tissue regeneration. Furthermore, it carries little risk of insult to the injury site when done correctly. Regular acupuncture (as often as once or twice daily if practical) during the early stages of recovery serves as a tremendous healing aid.

Third, when healthcare practitioners are available, I suggest seeing a homeopath and/or herbalist for custom medicaments such as tinctures, creams, and salves. In the absence of qualified practitioners, most pharmacies carry over-the-counter natural healing products. Arnica is great for soft tissue trauma, comfrey for bone trauma, and echinacea for infections.

Years ago I treated a dancer with a diagnosed third degree ankle strain that carried a prognosis of 6 weeks of rest. With daily acupuncture treatment and massage, plus herbal therapy, she was back dancing within a week. I think she was a bit overzealous in her return to activity, but the point is her recovery seemed to be greatly aided by PASTA and not RICE.

Holism is based on the concept of the synergism and interconnectedness of all body functions, and typically embraces the body’s healing wisdom. To stamp out the very symptoms that serve as a gauge of our state of health results in far more pervasive and severe complications, some of which may not come to light for years.