Save the RICE for First-Aid, Not Healing & Recovery

For decades, the standard and recommended response to an injured muscle, tendon or ligament was to “apply RICE,” an acronym that stands for a protocol of rest, ice, compression and elevation. 

Yet these days, according to Yorba Linda physical therapist Ruben Salinas, the application of RICE as a treatment for these sports-type soft-tissue injuries isn’t 100 percent supported by science. 

“Multiple studies have come out over the years that question the wisdom behind our reliance of RICE as a treatment for injuries, specifically as it relates to rest and the application of ice to the injured area,” said Salinas, owner of Salinas Physical Therapy in Yorba Linda. “Because of this, the role of RICE has changed in recent years.” 

RICE was coined in 1978 by Gabe Mirkin M.D., a legendary sports physician who introduced the procedure as author of “The Sports Medicine Book.” Four decades later, RICE continues to be a go-to treatment for sprains, strains and bruises. The protocol includes: 

Rest: Avoiding use of the injured area. 
Ice: The application of ice or a cold pack to the sore or injured area, though not directly to the skin. 
Compression: Wrapping the injured area to provide support, reduce blood flow and reduce swelling. 
Elevation: Raising the injured area or limb above the level of the heart to reduce swelling. 

Most recently, however – and based on newer research and evidence – Mirkin has stepped back from the suggestion that rest and ice stimulate healing. 

In doing so, he pointed to multiple studies, including one published in “The American Journal of Sports Medicine” which found no evidence that ice sped up healing and recovery. Additional research has found that icing an injured area can actually delay the healing process. 

This, along with additional evidence suggesting active recovery is better than rest for healing and recovery, has many in the physical therapy community reevaluating the wisdom behind the RICE protocol. 

“Rest and ice seem so engrained in the way we think about treating injuries it may be surprising to hear that both can actually delay healing,” Salinas said. “Over the years, we’ve learned that soft-tissue injuries heal better with mindful, active recovery.” 

In other words, soft-tissue injuries benefit from the use of low-intensity movements and exercises that stimulate recovery and repair – exercise guided by pain and movement limitations. Such recovery processes work best when led by a medical professional, such as a physical therapist. 

Does this mean RICE no longer has a role in treating soft-tissue and sports injuries? Not necessarily, Salinas says. 

“While RICE isn’t the optimal way to treat and cure many soft-tissue injuries, it can still be used effectively as a first-aid treatment,” Salinas said. “It can help the injured person bear the brunt of the initial wave a pain until the severity of the injury is determined. At that point, if movement is difficult or he or he can’t put weight on the injury, visiting a physical therapist for evaluation and treatment may be necessary.”