Is RICE Wrong?

There is growing evidence that suggests icing for recovery is not effective. Coaches and athletes have used the RICE (Rest, Ice, Compression, Elevation) method for years but now it appears that the Rest and Ice parts of the equation are actually wrong.


Rest results in muscle, tendon and ligament atrophy, which then leads to further weakness and re-injury. Rest also results in dampening of signals from nearby sensory nerve fibers, which normally serve to assist with balance and proper body positioning. With rest not only do we have atrophy and weakening of the supportive structures, we also lose some of the ability to stabilize and coordinate movements around the injured area, which is the perfect recipe for re-injury.


The theory behind icing for the first 48 hours following soft tissue injuries such as sprains has been that ice restricts blood flow and reduces swelling, thereby minimizing pain. The application of ice penetrates only a few millimeters of tissue and therefore may not be operative in deeper tissues. People tend to think the inflammatory response following exercise is a bad thing because it is painful and temporarily reduces athletic capability but it is actually a very important part of the recovery and adaptation process. The inflammatory response, though unpleasant, serves a very important purpose. Inflammation is a normal response to tissue injury, it signals the body to start the healing process. Inflammatory cells called macrophages release a hormone called Insulin-like growth Factor (IGF-1) into the damaged tissues, which helps muscles and other injured parts to heal. However, applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1. In fact, anything that’s goal is to reduce inflammation will hinder the healing process. That includes NSAID’s like Ibuprofen and cortisone type drugs.


Compression is directed towards reducing swelling. While compression may limit some tissue edema, it may also assist in lymphatic drainage by preventing thin lymphatic walls from being compressed by excess tissue edema. Compression also creates an acute bout of ischemia around the compressed area. Once the compression is removed, blood flow will rush to the tissues that were in an ischemic state. This increase in blood will bring the necessary nutrients to aid in the healing process.


Elevations primary value may be in enhancing lymphatic drainage from the site of injury and edema. This is because lymphatic drainage is governed by gravity. Elevating the affected area allows gravity to help the lymph fluid drain back towards the heart. Another and more effective way to aid in lymph drainage is through muscle contraction. Lymph vessels are surrounded by muscle tissue and as we contract our muscles, the lymph vessels are squeezed and the fluid is pushed along the drainage path. This is why active recovery is such a good method of alleviating muscle soreness. If you are unable to participate in an active recovery session due to an injury or another reason, there are now devices such as the MARC Pro, which allow you to get the same effects of active recovery, passively.

What is right?

A more logical approach involves restoration of joint alignment with the associative muscles, tendons, ligaments, nerves and blood vessels as quickly as possible after injury. By quickly elevating the injured limb and applying gentle but progressive traction on the joint (using jump stretch bands), normal alignment can be restored before loss of mobility occurs in response to pain. With the limb elevated, compression wraps and devices such as the MARC Pro being used to remove the edema from the injured tissue and into the draining lymphatic vessels. Early, gradual, and progressive movement of the injured joint in ranges of motion that do not exacerbate pain will enhance the recovery process through increased blood flow and lead to a much faster recovery.


E.Vand der Linde & Oschman, Z. (2011). Comparative Ultrasound study of acute lateral ankle ligament injuries rehabilitated with conventional and jump stretch flex band programs. African Journal for Physical, Health Education, Recreation and Dance, 17(4:1), 591-602.

Kraemer, W.J., H.A. Bush, and R.B. Wickham. “Influence of Compression Therapy on Symptoms following Soft Tissue Injury from Maximal Eccentric Exercise.” The Journal of Orthopedic and Sports Physical Therapy 31.6 (2001): 282-90. Web. 19 Sept. 2013.

Nishino, T., F. Chang, MD, T. Ishii, MD, and T. Yanai, MD. “Joint Distraction and Movement for Repair of Articular of Articular Cartilage in a Rabbit Model with Subsequent Weight-bearing. Editorial Society of Bone and Joint Surgery (2010): n. pag. Web. 15 Sept. 2013.

Shimmer, M. & Hartzell, D. (2007). Don’t Ice That Ankle Sprain! – The F.A.S.T. Approach to Preventing and Treating Sprained Ankles. At April 2009

Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999)

Mirkin, Gabe. "Why Ice Delays Recovery." Dr Gabe Mirkin on Health Fitness and Nutrition. N.p., 16 Mar. 2014. Web. 12 Sept. 2015.

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