RICE isn't dead …

[Rex Sanders]

For many years the standard advice for treating muscle injuries like sprains and big bruises was RICE – Rest, Ice, Compression, and Elevation, applied immediately and for several days afterward. The primary purpose was to reduce swelling and speed healing.

Turns out there wasn’t much evidence for that advice. But the counter-reaction has gone overboard.

For example, the NOLS/WMI update headline is “No more RICE.” But when you read further, that’s just partly true. Now they recommend short-term Rest, Ice, and Elevation for comfort. Compression is out completely.

Why am I bringing this up? Personal experiences.

Many years ago I played recreational volleyball about six hours per week. Unfortunately I sprained thumbs or fingers dozens of times before I learned to stop doing that.

But trial-and-error taught that the faster I iced the sprain, the faster I healed. Minutes counted. Playing through the end of a session meant several days to recover; applying ice within a handful of minutes usually meant I could play the next day. Rest and elevation also helped. And it doesn’t need to be ice – even cool water works.

Unfortunately “short-term RIE” isn’t quite as catchy.

RICE: it’s not dead … it’s resting.

— Rex

[bjc]

A number of sports med people are using motion, not rest as part of the treatment from the very beginning. Some also avoid ice and the use of anti-inflammatories. They also recognize that research on the use of compression is inconclusive but can be used if it makes the injured party feel more comfortable. My own experience with athletes is that the use of movement is quite beneficial. It will be interesting to see where the research and real world practice takes us. I should add that although there is evidence of the negative effects of icing, I can’t bring myself to not ice if I injure myself! Maybe icing becomes more beneficial when we rest rather than move the injured limb?

 

[Tom K]

“A number of sports med people are using motion, not rest as part of the treatment from the very beginning.”

It resonates with my experience back in the early 80s.  We ran a lot of trails on Mt. Tam in Marin County for part of our training.  Ankle rolls were an inevitable part of the scene and, if the roll was not too serious, we stopped to evaluate, then slowly started walking, then jogged a bit, and slowly picked up the pace until we were at group speed.  That worked for all but the most serious rolls that ballooned up and turned ugly shades of purple.  I don’t see why it would be any different today.

[jscott]

I’m big on ice. I think it’s the miracle drug. Seriously.

[Pedestrian]

Ankle rolls were an inevitable part of the scene and, if the roll was not too serious, we stopped to evaluate, then slowly started walking, then jogged a bit, and slowly picked up the pace….

+1

Exactly my experience – especially for the regularly active. The more miles I hike/run/jog each week, I find that the best “cure” for injuries is movement. Ankle rolls which would be showstoppers when I was not as active are not as concerning. Of course it can be painful to roll an ankle running downhill on uneven trails but nowhere as bad as it used to be. The only thing that is different now is my sustained weekly mileage is about 3x of what it used to be.

 

 

 

 

[Diane “Piper” Soini]

I don’t like ice. It’s too cold. I prefer ibuprofen. The max daily dosage of ibuprofen is 3200mg (prescription dose) and I take a lot less than that, so I think it’s safe enough.

[John S.]

I sprained my ankle on day 3 of a six day gila trip with 20+ miles left. A compression ankle thingie was amazing. It was thin to wear in the shoe, dried each night, prevented any swelling and stayed on til trips end. After taking it off for the drive home, my foot swelled.  For the backcountry I like compression first  and rest/elevation when convenient. I can do without ice. Different injuries may require different measures though.

[John S.]

I should have said…for that injury I liked compression first and then rest and elevation at breaks and at camp.

[Author]

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