You fall and injure yourself, let's say you roll your ankle or you feel that slight strain after exercise…..what is the first thing that you think of to help treat and help this issue? Most of us here would probably say Rest Ice Compression Elevation (better known as RICE). But do we actually know why we are doing this and also is there any point?
For those of you who don't know, Dr Gabe Mirkin was the first to term the phrase R.I.C.E and it was introduced to us back in 1978 in his Sportsmedicine Book. At the time it was a best-selling book and the term R.I.C.E instantly took off as the way to treat sports injuries.
Here's the thing though…..first, 1978 was a long time ago in the field of sports medicine and a lot has changed since then as research methods and access to facilities and technology is far greater than what we had back then. And of possibly even more importance, Dr Gabe Mirkin himself also now states that his initial recommendation is now flawed!
So what is the solution then? First, Ice has been shown to relieve pain. But that is about it. It does not help with the healing and in fact may actually slow things down. The process of injury is quite a boring explanation and I won't go into intense detail on the exact cells and systems that come into force when we get injured (for anyone who wants to take me out for coffee I am more than happy to explain it all then :)!). But the simple explanation is that upon injury, a cascade of inflammatory cells is released to help protect and heal the area. The word 'heal' is super important here. We need inflammation to help with healing. Ice restricts blood flow thus reducing the number of inflammation cells that can come to the area. If you reduce these cells then you ultimately slow down healing and possibly even reduce the areas capacity to heal, creating longer term problems (potentially).
The reason injuries hurt is because of the inflammation cells. The level of pain felt is not necessarily indicative of the level of damage either. It's hard to comprehend this I know, but again it gets very complex here. Think about when you have stubbed you little toe, or when we get a paper cut, these levels of pain can be very high, but the level of injury that occurs is minimal. Yet some of us can have slightly torn muscles (the shoulder area for example) and experience literally zero levels of pain. So it is important to distinguish the difference between inflammation and pain.
The next cardinal sin is that of Rest. Yes, rest does tend to make things 'feel' better. They say always heals. Whilst this is true there is an underlying problem with this and one which is of some significance. Whilst we rest, we allow things to heal. However, whilst we rest we lose muscle mass pretty quickly. This paper here (one of many I could cite) by Kilroe at al, 2020, showed that in young healthy men, 1 week in a brace and on crutches saw a 6.7% decrease in quadriceps muscle volume. I know we won't all be on crutches after every injury but it is important to state this as muscle wastage can occur rapidly without even knowing it and then you expose yourself to greater injury risk for the future.
So what can we do instead? Technically speaking, any injury that occurs should be fully rehabilitated. After injury, your bod lays down new collagen. If these new collagen structures are not put under enough force/stress then they may heal poorly and become a weak part of the kinetic chain. This weakness then leads to other muscle drivers taking on more load and 'imbalances' start to form alongside problems in other areas.
Recently, the BJSM published new guidance which is referred to as 'PEACE & LOVE'. This provides a much more comprehensive approach to injury treatment and muscle recovery, whilst ensuring rehabilitation takes place too. Whilst it is not an exhaustive list, it sure is a lot more informative than the 1978 R.I.C.E theory.
So next time you are injured, first off, my advice is to always seek medical help to ensure there is nothing seriously wrong. Second, rather than using the out dated and scientifically incorrect treatment, think of PEACE & LOVE instead and this will help you get back to your sport or daily activity quicker whilst also ensuring the risk of injury is reduced too.
