Cryotherapy funny

Ahh, the old R.I.C.E protocol. We all know it… Rest, Ice, Compression, Elevation. We know it so well in fact that it has stood the test of time, and has managed to mask and override the more current and scientifically valid, updated protocol for musculoskeletal injuries – that is; M.E.A.T. (Movement, Exercise, Analgesics, Treatment). The RICE protocol dates back to a 1978 Sports Medicine book written by Dr Gabe Mirkin. Since then, sports trainers, first aiders, mums and dads have adopted it without question to have the desired effect of rapidly assisting with the management and resolution of acute injuries to muscles, tendons, ligaments and joints.

But wait, what if we proved our Grandmothers incorrect in that you should never tilt your head up when you’ve got a nose bleed, or use butter on a burn, or not to go outside with wet hair because you may catch a cold. Medicine is an evolving science, and we need to keep up to date with reputable researched evidence and clinical trials. Just as Professor Tim Noakes recently tore out his entire nutrition section from his famed book, The Lore of Running, so too has Dr Mirkin reviewed his opinion on his RICE protocol. This was mainly in response to a study and meta analysis that were published in The American Journal of Sports Medicine, stating that ice, in lay terms, is not effective for healing sports injuries (and in many cases may cause more damage).

The reason why I’m “putting pen to paper” is mainly due to an incident that I witnessed at my daughter’s under 12 AFL footy game on the weekend. Each week a different parent is rostered on to be the designated “Trainer” for the team. Today was not my turn, however I thought that I should intervene in response to the first aid offered when one of the girls was ushered off the field holding onto her wrist. She had reached for the ball as it was going over her head and it had struck her hand bending her wrist in an awkward position. Immediately several instant ice packs were discharged from the first aid kit and ready to be packed onto her arm and wrist. I decided to step-in, in an effort to assist with assessing her wrist for damage, offering my taping skills for a compression bandage and encouraging them to avoid using the ice packs. After a double snub from the “first aider” and another parent, I decided I best walk away and leave this job to these well meaning “professionals.”

So, why should you drop the “R” and “I” from the outdated RICE protocol…

  1. Ice reduces inflammation which is necessary for healing. (Journal of American Academy of Orthopaedic Surgeons, Vol 7, No 5, 1999)
  2. Ice causes blood vessels to constrict which then delays the supply of healing cells to the damaged area. (Knee Surg Sports Traumatol Arthrosc, published online Feb 23, 2014)
  3. Ice has a negative effect on your immunity, which controls your inflammatory response, which is the first phase of healing.
  4. Following application of ice, it can take several hours for the blood vessels to dilate (open). The decreased blood flow may cause localized tissue death and nerve damage. (Cryotherapy and nerve palsy. American Journal of Sports Medicine. 1981)
  5. Immobilization or rest of the affected/injured area is extremely detrimental to joints, ligaments, tendon and muscles; resulting in them weakening, becoming stiffer, and offering less support. (What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults. Journal of Athletics Training. 2012)

So… what should you do?

  • The “C” and “E” are still applicable; that is compression (firmly applied bandage or tubigrip if available) and elevation (to stop blood pooling in gravity dependant areas).
  • As mentioned at the start of this post, the now accepted MEAT protocol…
    • Movement – within pain free range of motion.
    • Exercise – begin with prescribed rehabilitation exercises as soon as possible.
    • Analgesics – I’m not one for “popping pills” as an effective way to control pain. Natural forms of analgesia would be my first “go to” (such as heat, self massage, taping, compression bandage, movement, meditation).
    • Treatment – manual therapy is a clinically proven and beneficial management tool to assist with recovery from injuries.
  • Seek an expert/specialist – sports doctors, chiropractors, osteopaths, myotherapists and physical therapists are all able to play a vital role in diagnosing and successfully managing injuries.

Sure, ice can be used as a temporary analgesic (pain inhibiter) to reduce localized pain, however that would be at the expense of adequate healing. In my opinion, the only thing that an ice pack should be used for is to keep your drinks and food cool in your esky.

Play hard, and hopefully remain injury free.

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