It’s Time To Move On From R.I.C.E.
Written by Elmer Vazquez

Aches, pains, and injuries happen at the gym (albeit far less often than most other activities, including running)1,2,3.

What Is R.I.C.E?

When injuries happen, many coaches/trainers/healthcare professionals still recommend the old R.I.C.E protocol to their athletes. That is Rest, Ice, Compress, Elevate.

A Better Way To Handle Injuries

Let’s break down R.I.C.E and learn a better way: P.E.A.C.E & L.O.V.E

Rest– We all know the harms of a sedentary lifestyle. Current data shows being sedentary has about the same mortality / morbidity risk as smoking. Instead of complete rest, The key is to stay as active as possible while Protecting the injured area.

Protecting the injured area involves modifying activities or movements to an appropriate intensity. Coaches can help a lot with that process and be directed by healthcare professionals when necessary. Pain is your guide to know if it is appropriate or not, and pushing into very low levels of pain can be useful to accelerate healing and recovery.

Smart training to help individuals accelerate recovery involves Loading and Exercising the injured tissue appropriately as soon as possible. Early return to appropriate activity helps with Vascularization (improved blood flow/capillary formation) and improved metabolism around the injured site. I’ll mention again that pushing into very low levels of pain can be therapeutic at any stage, for most connective tissue injuries. This type of movement Optimism is valuable for recovery and helps address some of the psycho-social aspects of pain management.

Ice– There is a huge wave of Ice bath and cold exposure fanaticism in the wellness/fitness space. In general I am a huge fan of the hormetic (adaptive) response to stress. For example, exercise is a useful acute stress that can trigger improved recovery among other adaptations. Current data suggests cold exposure is disadvantageous for recovery.

Cold exposure is stressful in unique ways that are very different to exercise/training. Far too many people are ignoring the data showing how cold exposure slows down healing and decreases training response4,5,6,7. Cold exposure decreases blood flow and downregulates inflammatory cells/proteins, which is how it improves pain. Fun fact, that’s similar to how anti-inflammatory medicines like ibuprofen work, and they should also be avoided if possible.

Allowing inflammation is important for both healing and training adaptation. Icing and/or nsaids can be valuable for severe pain limiting sleep or activity, because then the pros of being able to sleep well and train appropriately outweigh the cons of the ice/medicine. If the pain is bearable, meaning you can sleep and exercise appropriately, avoid nsaid’s/ice.

“I feel amazing after icing/my ice bath though!”

Listen, your feelings are not reality. Just because you feel it less, doesn’t mean the tissue has any different quality. Decreased perception of soreness/pain is nice and likely worth it in some settings, like competition, to keep confident in your abilities (ie: for your mind).

Otherwise, is it worth the trade of missing out on training adaptations? If your performance improves more from some sauna / heat / compression over that ice bath, is there really a debate? Throw some heat on or get a gentle massage if you’d like to speed up recovery via more blood flow and faster cell/protein metabolism when you are not exercising/training. (Let’s remember that movement produces heat and raises core temperature more than sauna, one of the many reasons movement is THE medicine).

It’s worth noting if you are injury free and are not immediately post-training, an ice bath is not interfering with your gains. In fact it may be a useful stress in those moments, particularly for mood! Read more about that here.

Compression and Elevation- Compression and Elevation can be coupled together. They are not struck-through because they have great evidence for reducing swelling without interfering with the necessary inflammation for healing. They are part of P.E.A.C.E and along with exercise are the most important variables for addressing swelling. Compression/elevation help the lymphatic system do its job. Most manual therapies like massage / cupping / etc, are playing with compression in some manner (among many other useful multi-sensory stimuli to promote wellbeing).

TLDR / Take home points:

Rest and Ice are overrated/ineffective at best, and outright hurtful for recovery at worst.
Protect – Elevate – Allow Inflammation – Compress – Exercise or P.E.A.C.E > R.I.C.E
Coaches/Trainers/Healthcare professionals all play a role in helping injured athletes with L.O.V.E.: Loading – Optimism – Vascularization – Education aka good strength and conditioning programs appropriate to the athlete’s needs.

Hope you all can spread some peace and love!

Click Here to Learn / Read more in a slideshow style

Elmer Vazquez, CFL3, is a coach at Invictus Seattle and long time CrossFitter. When he isn’t busy as a student-physician, or as a coach, he is spending time with his wife and dogs, playing volleyball, or doing jiu-jitsu. Feel free to reach him via e-mail: ElmerDVazquez@gmail.com or Instagram: @ElmerDVazquez

References:

1- https://doi.org/10.1123/jsr.2016-0040

2- PMID: 30370310

3- PMID: 28253059

4- PMID: 16372177

5- PMID: 17261562

6- PMID: 12423186

7- PMID: 2736001 (first of a four part series)