RICE: Yes or No

[physiomitch]

Hi all

Here is a little brain teaser, which relates to the management of sports injuries. I have for a while now been questioning the effectiveness of RICE in acute injuries and would like to add this to the forum to see what the reaction is. I believe it is comparing logic and common sense and human physiology to theretical practice. I may be wrong, but then.....

Some of the answers in some threads have mentioned RICE in the initial phases. I have a few things which might make you think about this differently. Although it is widely held that this is an acceptible approach to use for acute injuries, I feel we may be missing the point here. Theoretically ice reduces swelling, inflammation and pain, restricts blood flow to reduce bruising, however, this is theory, and yes these are the effects of applying ice to the body. But why would we want to starve an injured area of a natural blood flow for anything up to an hour. Inflammation, swelling, pain, bruising are all natural part of the injury process, BUT THEY ARE ALSO NATURAL PARTS OF THE HEALING PROCESS! Without these the brain will never know for sure the injury occured. So reducing these inputs can severely diminish the body's ability to repair itself. Where is the research to prove RICE helps the repair process or shortens the recovery period of an injury? I have not seen any, just as I have not seen any regarding ice baths! It is a SYMPTOMATIC APPROACH, not treatment approach. The ironic thing is that if injured and left to its own devices the body responds with vasodilatation in the injured area, NOT vasoconstriction, which goes against anything we have been told. So if the body itself increases the blood flow to the area, why are we shutting it down? For repair to begin the body needs platelets, red and white blood cells in the area, so it makes sense to increase the amount of blood in the area, but this takes place almost immediately, yet if we restrict blood flow, this cannot happen. Bruising will eventually stop as blood vessels repair quite quickly, so we should not worry about that and swelling is from damaged cells...they cannot get any more damaged and only have a certain amount of fluid in them.

In my opinion we should focus more on trying to influence more blood to the area, not away from it. This can be done by using small doses of ice (10 secs at a time, removed until the skin warms up again), below the injured area if possible to stimulate flow THROUGH the injured area, not around it which is what happens with orthodox icing.

My opinion: RICE...rest, yes. Ice, NO!

What do you think?

[physiomitch]

Thanks Dr D

Good points made. Although I have to admit it sounded a bit like a horror movie your description of cell damage and death

One thing puzzles me though; I was under the impression that cell damage is expected even in the most minor soft tissue injury, and this is why fresh cells, mast/platelets etc are attracted to the area (electrically) and it is their job to produce the new cells necessary to repair the damage once the acute phase is complete. I was also under the impression that as inflammation is a normal process, the body would have a sequence of events to restrict the length of time that inflammation occurs, by controlling blood flow to the area, introducing enzymes to break down inflammatory substances, etc. The body is constantly monitoring its environment, and only in the most severe of cases should it be unable to handle the necessary repair.

I would also expect the increased metabolism to be both to remove damaged tissue, and also deliver new nutrients, hence again a natural mechanism which seems to be blamed for doing what it is designed to do. Heat is a part of that, not necessarily a mistake by the body. I agree that nutrition in the blood is no good if it cannot be taken up by the cells, but I think it is necessary to ensure the optimum rate of blood flow is obtained as soon as possible so that when it is needed it is there. I still am not happy with the concept of reducing inflammation, when the body can do it in the majority of cases. I am of the belief that if you slow down the rate of blood flow you slow down metabolism. Like any other physiological function in the body, metabolism depends on nutrition from blood flow.

"So rather than asking a question does ice help repair(because it does not), it would make more sense to ask when should I be using ice or why am I using ice in this situation?"...or should I be using it at all?

By the way, my immediate reaction to a burnt finger is actually to put my finger into my mouth. I experimented once because of this and found quicker relief putting a burnt finger (no I did not self-inflict...at least not on purpose!) under a hot tap. Still trying to understand the reason, but with ice the pain seemed to return quicker and more intensely after removing ice than after removing heat???

By the other way...speak for yourself as far as poor eating is concerned. I agree with your reply on the food for sure.

My comparison with nature in this caase was mainly to do with animal reaction to injury, stress, or regular habits, not affected by diet. See next reply.

By the way fellow Physios, I think we could easily add this discussion on the CPD portfolio as research??

[physiomitch]

Hi all

Wow! This is becoming an interesting site. I think i have learnt more in the past few days thanin my 4 years of study.

With regards to the stretching comments, I think it might be a good idea to start another thread on this in sports physio/sportsmedicine, as I feel it may be as good a subject as this one, and also i do not wish to dilute this thread with something different, as new members or readers may want to add more.

So please go back to the sports physio forum and look for the next thread 'Stretching: before or after warm-up?'

Woah! Not yet i ahve not started yet...

See you there...and here again I am sure.

Pete

[Canuck Physio]

Yes, I think this is beginning to go off tanget,
but in regards to Ice therapy.

Consider that when for example we do burn our fingers, we know that heat conduction occurs beneath the skin, subsequently causing necrosis of deeper layers of tissue.

If a physical insult can potentiate damage via kinetic energy which may effect the body and subsequently results in increased heat around the area of damage, I can see why Ice Therapy can be important here.

[Dr Damien]

Physiomitch

that was a very funny reply and I enjoyed every bit of it.