Sports Medicine Monday: The Efficacy of Ice on Acute Injuries

By Dakota Thompson, ATC

There have been many clinicians that have been using the R.I.C.E protocol to help treat acute injuries for many years. In fact, the first occurrence of using ice in the 1960s for medical treatment came when a 12-year-old boy had a limb reattached by preserving the limb with ice. News of the successful procedure led to ice eventually being used on acute injuries. The term RICE comes from Dr. Gabe Mirkin, who published the term in the 1978 Sports Medicine Book. Since then, Dr. Mirkin came out in 2015 and recanted those statements on RICE and how effective on acute injuries it actually is. The research that has been done has shown that the use of ice on acute injuries can actually delay and impede the healing process.

The physiological response to injuries comes in three steps: inflammation, repair, and remodeling. This is a fixed sequence of events where each step must happen in order to go to the next one. Inflammation is usually associated with swelling, but it’s more complex than that. Inflammation is actually the first step in the repair process, while swelling is the build-up of waste product from the inflammatory response that has not yet been removed from the site of injury. Inflammation does not need to be reduced or delayed when treating an acute injury, as it is the body’s natural response to an injury. During the repair phase, the macrophages are excreting waste products in the form of fluid (swelling). The body’s natural process of removing swelling is through the lymphatic system, which relies on voluntary muscle contractions to help propel lymphatic drainage. The accumulation of swelling at the site of injury stems from an inadequate amount of early voluntary muscle contractions. Lastly, The final phase of the repair phase is the construction of a temporary extracellular matrix laid down by fibroblasts and collagen-producing cells. The recovery process will be complete once a vascular network has been reestablished and the temporary matrix has been replaced by the stronger, final product of cells.

The original purpose for applying ice on injuries was to help reduce the overaccumulation of swelling at the affected site. The application of ice acts as a vasoconstrictor of the local blood vessels. This will cause the body’s physiological response to the injury to be affected negatively as the healing properties will struggle to reach the site of damage. Another outcome of applying ice is that it creates a hypoxic environment, causing cell death.

A more optimal approach to treating an acute injury will be the implementation of early movement of tissues. An active recovery can help facilitate lymphatic drainage of excess waste products. A new acronym has been proposed as a replacement to“RICE, called MEAT. The term MEAT stands for movement, exercise, analgesia, and treatment. This protocol suggests moving the tissue through a pain-free range of motion to encourage lymphatic drainage. The next step focuses on exercising with resistance outside of the range of simple movements.

Next is the analgesic step, where we evaluate the use of NSAIDS (non-steroidal anti-inflammatory drugs) such as Ibuprofen, Motrin, and etc. There is evidence to suggest that the use of NSAIDS may actually prolong recovery as they produce prostaglandins, which initiate inflammation. An alternative to NSAIDS is Tylenol as it won’t disrupt the inflammatory response, but proper dosing should be followed as it has been linked to liver damage. Any use of medications (over-the-counter or prescription) should be done so in consultation with a health care provider.

The final stage of MEAT treatment is a broad category but involves using a wide range of therapeutic interventions that vary for each patient, including the use of cryotherapies.

The application of ice will continue to serve value in the medical field, but in other ways that are conducive to the patient. If the goal is to help reduce pain due to injury, the application of ice can help to some degree with the numbing of pain. There will be many different philosophies that may come to replace the RICE protocol, but one that is based on an active recovery such as MEAT that has been researched will continue to help those with an acute injury.

Citations

1. Academy USS. The R.I.C.E Protocol is a MYTH: A Review and Recommendations.
The Sport Journal. Published October 30, 2020. Accessed August 8, 2022.
https://thesportjournal.org/article/the-r-i-c-e-protocol-is-a-myth-a-review-and-recommendations/?_ga=2.224615258.1997713310.1659966206-1886844848.1659966206

2. R.I.C.E. is Wrong: Healing Injuries | By Dr. Andrew Wojciechowski, ND - Correct
Toes®. Published February 2, 2022. Accessed August 8, 2022.
https://www.correcttoes.com/foot-help/r-i-c-e-is-wrong-healing-injuries-by-dr-andrew-wojciechowski-nd/