By Kyle Dorsey, PT, DPT

For years members of the healthcare world have prescribed R.I.C.E (Rest, Ice, Compression, Elevation) following an acute injury but is this really the best treatment option? 

Dr. Gabe Mirkin, a Harvard University physician published “The Sports Medicine Book” where he originally prescribed applying ice to an injured area. Since then, this treatment has been adopted by almost all members of the medical field as well as today’s top athletes. There are many reasons why we were taught to apply ice to injuries from pain prevention to decreased cellular metabolism, decreased inflammation, and decreased swelling; but is this really the best injury for acute injuries? 

In 2013 an updated book titled “Iced! The Illusionary Treatment Option” was published and Dr. Gabe Mirkin (the creator of the R.I.C.E. protocol) wrote the forward for the book where he actually redacted his previous research. Additionally, Dr. Mirkin now promotes light activity and movement as the optimal method for treating acute injuries. 

Why is this important? 

Originally, we are taught that swelling is bad, that it leads to more harm than good, and we need to reduce the swelling as quickly as possible. While this may be true in some cases (chronic swelling or swelling leading to significantly limited mobility) in most cases swelling is a good thing! Swelling is the bodies natural response to tissue damage. When we sprain or ankle we damage tendons, ligaments, muscle and in more severe cases the bone. When this happens, we get an influx of dead or dying tissue cells. For the body to clear out these dead cells and any possible foreign debris (if there is an open wound) the body reflexively increases blood flowing to the area. By increasing blood flow to the area, the body is now able to transport more white blood cells (responsible for cleaning up the dead/damaged cells), platelets (to limit bleeding) and histamine (a chemical that allows for more blood to reach the area and allows for nutrients to cross out of blood vessels and into tissues much easier) into the injured tissue. 

This is an important immune response and is necessary to transport out any dead or damaged tissue and allows the body properly to heal. While ice is still recommended to help reduce pain, it may not be the best treatment for acute injuries and swelling. So, what should we be doing instead?   

Instead of ice it is recommended that people perform light activity and movement. This light activity/movement allows the body to properly create and lay down the necessary tissue needed to restore the muscles, tendons, ligaments, and joints to their pre-injury status. 

Not sure what exercises or activities you should be performing following an acute injury? Visit one of our locations or contact Performance Plus Physical Therapy for an evaluation and assessment as well as advice on safe and effective treatment for acute injuries!


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