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RICE: The End of an 'ICE Age' for Injury?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Craig Payne, May 31, 2014.

  1. Craig Payne

    Craig Payne Moderator


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    This is getting a bit of attention in the blogsphere:
    RICE: The End of an Ice Age
  2. I don't know a single sports medicine physician that doesn't recommend modified rest and icing for treating acute sports injuries. I have used ice and modified successfully also in treating chronic athletic injuries for three decades.

    Someone is going to have to produce some very good research evidence for me, and thousands of other sports physicians, to stop using ice and modified rest for our injured patients. What are we supposed to do for our athletes with acute ankle sprains, have them exercise more and have them put heating bags on their ankles?? :butcher::bang::craig:

    How is this advocating "an end of an "ICE age" for injury????"

    This is the exactly the way the barefoot running fad started....internet driven half-facts whipped up by the media to cause artificial controversy. I think we are seeing history trying to repeat itself.

  3. David Smith

    David Smith Well-Known Member

    I know from my days of competitive Judo that icing, and a great and frequent tendency to ankle sprains due to a lateral STJ axis (i later found out) strapping and rest with mobilisation and gradual activity was the way to quick recovery as opposed to doing nothing but the most important of thoise was to get cold compress or icing asap i.e. dont let it swell up.

    Interestingly though I often found that not giving into the pain and just carry on training (right at the point and time of injury) would result in the injury resolving even more quickly. However if the injury was to painful to weightbear then this option is impossible and RICE was best.

    I know also that patients are amazed when, if they come to me early, that with RICE plus mobs and orthosis they can be pain free in a few days, unfortunately they usually got to A&E - minor injuries dept or GP and get a bit of tubigauze and told to rest with NSAIDs perhaps and the injury last for weeks until they eventually come to me, when ICE strapping / taping, orthsoes mobs does the trick.

    Regards Dave
  4. RobinP

    RobinP Well-Known Member

    I am perhaps wrong here but I thought that the protocol now was "POLICE" - fancy!

    Protect - Strapping/orthosis/cast boot
    Optimal Loading - not complete rest but maintaining some degree of load through a structure(eg inversion injury - partial weight bearing, gradually increasing as inflammation reduces
    Ice - 10 mins in every 30 mins
    Compression - Tubigrip
    Elevation - For periods interspersed with some appropriate loading

    Really, it is not so distinct from RICE. I think we can all recount anecdotal tales of when complete rest has been detrimental to healing. Protection and optimal loading seems to be reasonable.

    The assumption is, as always, that the patient is sufficiently switched on to make some common sense decisions. For example rest means relative rest, not kick your feet up for 4 weeks and use a hand bell to summon your subjects to attend to your every whim. Optimal loading means - don't keep playing football but greatly reduce the loading through the injured structure. Both are ambiguous, perhaps at opposite ends of the scale
  5. First of all, the "R" in RICE, rest, has never been "total rest" during my thirty years of being a sports podiatrist, it has been "modified rest" meaning, for example, that a runner with a running injury will need to do some other activity that isn't running for a while, or run slower or shorter distances, rather than "total rest". I've never heard any respected sports physician in the last quarter century recommend "total rest" for treating an athlete.

    Second, the "I" in RICE, icing is still being advocated by Dr. Mirken for pain relief and is still being used in acute injuries worldwide. In addition, in my clinical experience, icing is better than heat in allowing athletes to train through tendon and ligament injuries. Should we stop judiciously using ice along with other modalities to treat both acute and chronic injuries? Absolutely not!!

    Third. the "C" in RICE, compression is used in acute and chronic injuries to reduce edema worldwide. I see no evidence to suggest to stop using compression for lower extremity edema.

    Lastly, the "E" in RICE, elevation, is used in both acute and chronic injuries to reduce edema worldwide. Again, no evidence to suggest stop using elevation for lower extremity edema.

    Now, what was the point of the article again? What exactly has changed or should be changed? After reading the article, they aren't telling us anything that most of us didn't already know or haven't already used for at least the last 2-3 decades!!

    Again, as I said before, another example of:

  6. j1nxst3r

    j1nxst3r Member

    This is an interesting thread (if not a little strange) as we pod students are still being taught that RICE is THE preferred method for acute injuries.

    It'll make for some good debating material for the teaching staff when I show the article to them.


  7. mr2pod

    mr2pod Active Member

    It is still the preferred treatment from first aid point of view aswell, coming from the paramedics it is now known as "RICER" for the first aider.
    Rest, Ice, Compression, Elevation, Refer (to medical expert).
    The update i did last weekend suggested Ice for 20 min and not again for 2 hours.
  8. Orange23

    Orange23 Welcome New Poster

    What are your opinions on using NSAID (topical or oral) for an acute injury?
  9. David Smith

    David Smith Well-Known Member

    I would have said until recently that they are useful for treatment of MSK injury, however it now seems to be considered by many that NSAIDs are not so useful except for early pain relief. NSAIDs do reduce pain and inflammation in early stages but they may also retard healing and remodelling of bone and soft tissues particularly tendon, ligament and muscle. On a recent course two professors in MSK rheumatology and pain management spoke about these principles but then again they were also promoting pro inflammatory interventions over the anti inflammatory approach and in particular use of Autologous Platelet Rich Plasma therapy within which NSAIDs are totally contraindicated.
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