Should I Ice An Injury? Skip the RICE, get some MEAT

Whether you’ve overdone it in yoga class or found yourself with a stiff neck from not paying attention to form during CrossFit, it’s likely you’ve experienced a musculoskeletal injury that required RICE – the acronym for rest, ice, compression, and elevation.  RICE has been prevalent since the 1970s, and is often touted as best approach to dealing with sports and soft tissue injuries. It is based on the idea of reducing inflammation.  Which makes sense, if you think about it – if you’re injured ice feels good on the area and resting keeps you from aggravating the injury.  However, just because something sounds like it makes sense doesn’t necessarily mean it makes sense.

What Gives?

Recent research has shown that RICE isn’t the best course of treatment for soft-tissue injury. Perhaps more surprising than this news is who is leading the charge against RICE. Dr. Gabe Mirkin, the doctor who created the RICE treatment guidelines in 1978's The Sportsmedicine Book, recently authored an article in which he stated that both ice and rest may delay healing of soft-tissue injury. Coaches, physicians, physical therapists and the lay public have recommended and followed the “RICE” guidelines for decades, but, as Mirkin states, “it now appears that both ice and complete rest may delay healing, instead of helping.”

Why Ice is for Dead Things

Recent peer-reviewed journal articles reinforce this idea. Studies are showing that icing can cause muscle damage, fatigue, and delayed recovery. Furthermore, icing to reduce swelling has been show to delay healing because it delays the body’s natural inflammatory response. Anything that reduces inflammation or the immune response will also delay healing; this includes cortisone, NSAIDs, immune suppressants, and cold packs/ice.  Also, ice applications can negatively affect athletic performance because icing reduces strength, speed, endurance, and coordination because it decreases blood flow to soft tissues and decreases skeletal metabolism.  As we say in Chinese Medicine, “ice is for dead things” – living tissue should never been supercooled; blood flow and movement should always be encouraged instead.

Resting an injury has similar effects — though immobilizing an injury doesn't necessarily "close the lanes" in your blood vessels, it certainly isn't helping your blood cells move any faster. When you move, your heart pumps more blood, which means the injured site can get more resources, more quickly. A comprehensive 2012 study of ankle sprains stated that those who had their sprained ankles immobilized with splints and crutches required more missed days of work and more medical treatment than those who gently moved their injury early and often.

Add some MEAT

The emerging trend in sports medicine is moving away from RICE and towards MEAT – movement, exercise, analgesia, and treatment. MEAT is based on the premise that inflammation is your body’s natural healing mechanism; inflammation involves a complex series of biochemical events that concentrate white blood cells, platelets, and growth factors to the area of injury to allow cleanup and repair. When you experience a musculoskeletal injury, skip the ice pack and try this instead:

• Movement = to pain tolerance; this prevents adhesions and increases circulation.  Try “writing the alphabet” with the affected area.
• Exercise = next level beyond gentle movement; encourages further growth and strength, improves circulation.
• Analgesia = If you are in discomfort, skip the pill bottle and manage pain via acupuncture, cupping, herbs, and other modalities.
• Treatment = Check in with your acupuncturist for treatment; acupuncture can help heal the injury and boost your overall health and wellness.  

The Bottom Line

RICE has its place – its best use is immediately and sparingly.  Use only during the first 2-4 hours following an injury and cycle the use of ice application (10 min on, 10 min off). RICE is also very effective at treating compartment syndrome, a rare but serious conditions most often involving a bone break or severe muscle tear.  MEAT should comprise the majority of your treatment.  Early mobilization helps soft tissue healing and encouraging the body’s natural inflammatory response speeds muscle recovery and improves circulation to ligaments and cartilage. 

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References

Mirkin G. Why Ice Delays Recovery. March 16, 2014. http://drmirkin.com/fitness/why-ice-delays-recovery.html. Accessed June 4, 2014.

Malone T, Engelhardt D, Kirkpatrick J, Bassett F. Nerve injury in athletes caused by cryotherapy. J Athl Train. 1992; 27(3): 235–237.

Tseng CY, Lee JP, Tsai YS, Lee SD, Kao CL, Liu TC, Lai C, Harris MB, Kuo CH. Topical cooling (icing) delays recovery from eccentric exercise-induced muscle damage. J Strength Cond Res. 2013;27(5):1354-61. doi: 10.1519/JSC.0b013e318267a22c.

Tidball JG, Wehling-Henricks M. Macrophages promote muscle membrane repair and muscle fibre growth and regeneration during modified muscle loading in mice in vivo. J Physiol. 2007; 578: 327-336.

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Nemet D, Meckel Y, Bar-Sela S, Zaldivar F, Cooper D, Eliakim A. Effect of local cold-pack application on systemic anabolic and inflammatory response to sprint-interval training: a prospective comparative trial. European Journal of Applied Physiology. November 2009, Volume 107, Issue 4, pp 411-417.

Ho SS, Illgen R, Meyer R, et al. Comparison of Various Icing Times in Decreasing Bone Metabolism and Blood Flow in the Knee. Am J Sports Med. 1995; 23(1): 74-76. doi: 10.1177/036354659502300112.

Drez D, Faust DC, Evans JP. Cryotherapy and nerve palsy. American Journal of Sports Medicine. 1981; 9:256-257.

Van den Bekerom MP., Struijs PA., Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GMM. What Is the Evidence for Rest, Ice, Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults? Journal of Athletic Training. 2012;47(4):435-443.