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  • Tom Toth

Time To Put R.I.C.E. on Ice


Why do we ice injuries?


Everyone knows that when you hurt a part of your body, you put ice on it to keep swelling down and help it heal. Twist your knee? Ice it. Bump on the head? Ice it. Your ankle is swollen after a hard run? You know it! Time to put ice on that bad boy. Turns out this concept, so ingrained in our minds, is completely wrong!


Before your head explodes, let me explain. The whole concept of Rest, Ice, Compression, and Elevation was developed in 1978 by Gabe Mirkin, a doctor at Harvard University. He thought that reducing swelling and inflammation by resting the damaged tissue and cooling it with ice would accelerate the healing process. At that time, swelling was considered a negative side-effect of injury that slowed down tissue repair.


While chronic swelling of a joint is definitely not good, the extra fluid that gathers at the site of an injury is not a bad thing. In fact, it is full of healing substances. As more fluid moves through the area, it helps clear away the damaged bits through the lymphatic system, while blood brings in macrophages and proteins that start the repair process. Icing an injury slows down fluid movement, and actually impairs the healing process. Don't do it. There are almost no exceptions to this rule.


No rest for the injured


What about the "R" in RICE? Should you rest the affected area after an injury? Definitely, but for far less time than you might think. Let's say you went out for an over-ambitious run, and now your Achilles tendon is really sore. You might think you need to let it rest for weeks (maybe ice it twice a day, right?), then return to running when it feels 90% better. The problem is it might take months for that to happen. Tendons take a very long time to heal when left to their own device.


A better approach would be starting a rehab program almost immediately to accelerate healing (and definitely no ice). Tendons need strength to become resilient, not rest. Rest makes them weaker and your return to activity will be much more difficult after a multi-month lay-off. A rehab program for a simple tendon overload usually isn't overly complicated, but other injuries may need more attention. I recommend seeking out a competent physiotherapist who specializes in the injury you have to get the best and fastest outcome.


What about compression and elevation?


Well... they are fine. They aren't going to cause much damage, and they may help a bit with fluid circulation. The only exception is too much compression. Don't do that: it can lead to nerve issues and you may cut off your circulation. A simple compression sleeve will work better than some home-rigged contraption.


What to do instead of R.I.C.E.


Lots of new protocols have emerged recently to replace R.I.C.E. They all recommend slightly different things, but three themes emerge when looking at them as a whole:


1) heat over cold: warming an injured muscle or joint increases fluid circulation, nutrient delivery and healing. Some people like a short bit of icing if there is too much swelling, immediately followed by a heat pack.


2) movement over rest: movement therapy should start almost immediately. There is a reason why patients with knee replacements start therapy the day after surgery: it provides for much better outcomes. Starting with very gentle mobilization and progressing into a resistance training routine is the way to go, but be sure to get good advice on how to proceed.

anti-inflammatories are not good for recovery

3) anti-inflammatories are generally a bad idea. I'm talking about taking Advil for minor inflammation or injuries. Inflammation is the body's normal response to injury, and without the inflammatory signals that emanate from the damaged tissues, our repair system does not become aware that something needs to be fixed. Anti-inflammatories may help you feel better short term, but they cause long-term damage.


4) if an injury stops you from doing the exercise you love, do something else. If you can't run, bike. If you can't lift weights, do yoga. Becoming deconditioned because something hurts will lead to more injuries over the long run because it makes it harder to get back into exercise.


Focus on active recovery


Mindset is critical if you get hurt. Tell yourself that it's not the end of the world. Everyone gets tweaks and aches, even the best athletes in the world. Acute injuries are best treated by a physiotherapist, and we have many good ones here in Leaside.


However, if you are dealing with a long-term ache or annoying muscle pain, this is my bread and butter as the Leaside Trainer. Let me know at tomtoth.iron@gmail.com and let's build back some strength and endurance! Most chronic muscle and joint pain can be improved with exercise and mobility work. Let me show you how!

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