“RICE” (Rest, Ice, Compression, and Elevation) has been a common theme among many practitioners, coaches, athletes, parents, etc., to start the rehabilitation process when an injury occurs. Your body has its own mechanisms to repair injuries. For the majority of the time, we should rely on our body to repair itself. Some governing bodies still use this mnemonic to treat injuries to this day. This acronym is not totally false, but it’s not entirely true, either.
Our body has two systems that are closely related to recovery: the circulatory system and the lymphatic system. The lymphatic system is primarily responsible in healing the body. The lymphatic system constitutes a one-way transport system that operates in conjunction with the circulatory system. Its primary function is to transport excess interstitial fluid, from the interstitial space, back to the blood circulation, via the thoracic duct.(1) Think of this as a one way road to the city dump. One thing that aids in ridding waste through the lymphatic system is muscle contraction due to the compression of the muscles. A muscle contraction can be as little as walking or jogging. If the area is immobilized, it can be as simple as wiggling the fingers or toes. Muscle contractions act as a plunger which pulls the waste out of the muscle.
When we hear rest, we normally think of posting up on the couch, immobilizing the affected area. With some injuries such as broken bones, severe sprains, etc. we have to immobilize the area because it can’t be moved without excruciating pain. But, with other less severe injuries, we tend to rest them too long. This could potentially increase the amount of time it takes for the injury to heal. Muscle activation is the key to remove waste and deoxygenated blood which is causing inflammation. Without muscle activation or contraction, the lymphatic system is not as efficient in ridding the area of deoxiginated blood and waste. Rest doesn’t really make sense in this case. Don’t try to flex a broken bone, duh. But, do come up with a way to vacate the swelling from the inflammatory cycle.
Ice and cold water immersion has been highly refuted by most studies. Topical icing and even ice baths (which are used by many athletes on a professional level for recovery) actually shut off signals between muscles and nerves, which can prolong the recovery time. “When ice is applied to a body part for a prolonged period, nearby lymphatic vessels begin to dramatically increase their permeability (lymphatic vessels are ”˜dead-end’ tubes which ordinarily help carry excess tissue fluids back into the cardiovascular system). As lymphatic permeability is enhanced, large amounts of fluid begin to pour from the lymphatics ”˜in the wrong direction’ (into the injured area), increasing the amount of local swelling and pressure and potentially contributing to greater pain.” (2) Many people are under the assumption that more ice is better, but it actually has the opposite effect. Generally, people spend extended periods of time (~20-30 minutes) icing one area. Within this time frame it is possible that some negative effects, such as frostbite and nerve damage can occur. There is a time and place for ice, but it easily can be used in the wrong context.
Compression and elevation are still good things. To go along with the idea of the muscles forcing the waste into the lymphatic tubes due to contraction, compression can help do the same. Compress the area tightly (without cutting off circulation) with elastic bandages, clothing, etc. Compression should be applied very shortly after an injury has occurred. Elevation can be applied in this case as well. Elevation above the heart can help decrease buildup of waste and deoxiginated blood to the affected area.
“RICE” does not do our injuries justice any more. Remember to compress and stay as mobile as possible, while keeping the injured area safe from re-injury.
K. N. Margaris and R. A. Black. Modelling the lymphatic system: challenges and opportunities. Journal of The Royal Society Interface. (2012). doi:10.1098. rsif.2011.0751. Published Online
Meeusen R, Lievens P. The use of Cryotherapy in Sports Injuries,’ Sports Medicine, (1986) 3.6. 398-414. Print.