This post was written by Daniel Hernandez, a graduate physical therapy student in Texas State’s Doctorate of Physical Therapy program. Daniel is finishing up his last clinical internship at Symmetry and will graduate in May.
To “RICE” or not to “RICE”: the age-old question. The RICE method for treating acute injury has been around for decades and many individuals, including myself, have used it with success. Today, I will be discussing the RICE method as well as a newer method named “PEACE & LOVE” in terms of managing acute soft tissue injuries. Let’s begin with what the RICE method is and where it came from.
RICE is an acronym that stands for Rest Ice Compression Elevation. The term RICE was coined in 1978 by Dr. Gabe Mirkin in his book called “The Sports Medicine Book”. More recently, and especially during the last decade, there has been a push by healthcare providers to avoid the RICE method, as there are similar alternative treatments that yield better results. In 2015, Dr. Mirkin actually went back on his original statement and reasoning behind RICE. He stated that using ice on an injury may delay the healing process, and that therefore acute musculoskeletal injuries should not be iced.
As medical research has continued to evolve, we are learning that the RICE method may actually be doing the opposite of what we want it to do. Specifically, the icing portion of the treatment sequence seems to be counterproductive. We have learned that although ice can provide temporary relief for injuries, it may actually be SLOWING DOWN the healing process.¹˒²˒3 Peter Tiidus, a Professor of Kinesiology at Brock University in Ontario, has concluded through his research that “Cryotherapy or icing, as currently practiced, will not likely be successful in cooling human muscle sufficiently to have any significant influence on muscle repair, regardless of the degree of injury. However, based on studies in animal models, it may be that if sufficient muscle cooling could be achieved in humans, it could actually delay repair and increase muscle scarring following recovery from significant muscle damage”. ¹ The researchers of one study looking at icing vs. a sham (fake) treatment concluded that “Icing attenuated or delayed the infiltration of inflammatory cells, the expression of proangiogenic factors, and change in vessel volume in muscle following injury” ². These words basically indicate that the healing process was hampered. In summary, it seems that both current research and medical experts agree that icing could delay recovery.
So what SHOULD we do, then, when we have an acute soft tissue injury? Let’s begin by looking at each step of the “PEACE and LOVE” method of caring for injury.
P = (protection): Initially after an injury it is important to protect the injured area. This would mean that you should move less or put less weight or stress on that injury if possible. A few days of protection should be plenty for most injuries. But it is always appropriate to listen to your body and potentially consult with a local physical therapist if you are unsure.
E = (elevation): For this portion of the method to be most effective, you need to elevate the injured body part above your heart if possible. This helps to limit swelling and facilitate circulation within the body to assist with the healing process.
A = (avoid anti-inflammatory modalities): Inflammation is actually needed in order for your body to heal and is an indication that your body is doing its job! Therefore, taking anti-inflammatory medication such as ibuprofen (Advil) or using anti-inflammatory strategies such as ice may actually slow down the healing process! 3
C = (compression): This is important because compression can help to limit excessive swelling. Gentle pressure also allows for greater transportation of fluid in the injured area, leading to quicker healing.
E = (education): Seek out a local physical therapist who can provide you with more details about your injury and about how to approach the recovery process for your specific needs.
It is recommended after the first few days of PEACE you can now enter the LOVE portion of injury care.
L= (load): Once your symptoms have decreased it is important to attempt to return to your previously usual life activities as much as can without a great increase in symptoms. This will help get your body reaccustomed to weight bearing and/or resisted activity and start to rebuild your tolerance to body load and activity.
O= (optimism): This is an often-overlooked aspect of the recovery process that is vital. Research shows that individuals with a more positive attitude towards their injury/recovery tend to experience good results!4
V= (vascularization): This word means growing blood vessels into a tissue to improve oxygen and nutrient supply. Improved blood supply in an injured area can help the body to rebuild. Promoting vascularization can be accomplished by performing some sort of cardiovascular activity such as walking or stationary bicycling to help increase blood flow into the area of your injury.
E = (exercise): This will allow your body to begin to return to your previous level of strength, mobility, and proprioception. Ideally, exercise is prescribed with specific instructions, with activities directed towards improving the condition of the particular body tissue that has been injured. For example, injured bone tends to repair when it is stimulated with pressure. Tendons repair when tension is applied with stretching and pulling activities.
In a recent article published by the Canadian researchers Dubois and Esculier, it is explained that the PEACE & LOVE method for injury care is thought to be superior to the RICE method due to the fact that complete rest and the application of ice may not actually help to facilitate healing. Also, these clinicians observe that the RICE method only focuses on the acute management of an injury as opposed to also considering later stages of healing.4
In conclusion, next time you find yourself with a minor injury, you might consider ditching the ice and instead trying to remain as active as possible while also protecting the injury. Think about “PEACE and LOVE”, which perhaps will allow you to get back to doing the things that you love quicker!
- Tiidus PM. Alternative treatments for muscle injury: massage, cryotherapy, and hyperbaric oxygen. Curr Rev Musculoskelet Med. 2015;8(2):162-167. doi:10.1007/s12178-015-9261-3
- Singh DP, Barani Lonbani Z, Woodruff MA, Parker TJ, Steck R, Peake JM. Effects of Topical Icing on Inflammation, Angiogenesis, Revascularization, and Myofiber Regeneration in Skeletal Muscle Following Contusion Injury. Front Physiol. 2017;8:93. Published 2017 Mar 7. doi:10.3389/fphys.2017.00093
- Tseng CY, Lee JP, Tsai YS, et al. Topical cooling (icing) delays recovery from eccentric exercise-induced muscle damage. J Strength Cond Res. 2013;27(5):1354-1361. doi:10.1519/JSC.0b013e318267a22c
- Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020;54(2):72-73. doi:10.1136/bjsports-2019-101253