For years, the RICE (Rest, Ice, Compression, Elevation) protocol has been recommended for treating acute musculoskeletal injuries. However, recent research suggests we might need to rethink this approach.
Introduced in 1978 by Dr. Gabe Mirkin and Marshall Hoffman, the RICE protocol was widely adopted without substantial evidence to support the underlying theory or the results in practice.
While ice application can offer immediate pain relief by slowing nerve activity, its benefits beyond the immediate post-injury phase are debatable. Ice is believed to be most effective immediately after an injury, to reduce the inflammatory process and speed up the transition to the body’s natural anti-inflammatory phase. However, ice application often occurs too late after an injury to significantly help recovery, and when applied too late or for too long after an injury may actually lead to delayed repair and even increasing unwanted scar tissue.
Current icing protocols suggest only using ice for the first 12 hours after injury and applying ice only for around 20 minutes at a time. The sooner ice is applied, the more helpful it will be. Contemporary post-injury protocols now emphasise the importance of optimal timing and degrees of mobilisation and tissue loading, which we will discuss in an upcoming post.
Interestingly, Dr. Mirkin, one of the original proponents of the RICE protocol, publicly revised his stance in 2014, suggesting that icing might blunt the natural healing response.
While ice has traditionally been a staple in treating acute injuries, modern research suggests that ice should be used less than most people would expect. It's essential to consider the specific context and individual patient/athlete needs. At Modbury Physio, we stay updated with the latest research to provide the best care for our patients.
"Is it the End of the Ice Age?" published in the International Journal of Sports Physical Therapy Vol 18, No 3 in 2023 by Susan Kwiecien PhD.