For decades, the R.I.C.E. method – rest, ice, compress and elevate – has been the principal method for injury recovery.
The technique has evolved over the years, but has it been replaced by better methods?
Origins of R.I.C.E.
R.I.C.E. was predated by the shorter I.C.E. method, whose specific origins are unknown. In fact, according to an article published to the World Journal of Clinical Cases in 2021 by Zi-Ru Wang and Guo-Xin Ni, the term seems to have been coined without scientific evidence sometime before 1978.
R.I.C.E. was developed by Dr. Gabe Mirkin and colleagues, and published in The Sports Medicine Book in 1978, adding rest to reduce inflammatory response to the injury.
The acronym has seen variations over the years, including P.R.I.C.E., which adds protection, and P.O.L.I.C.E., which removes rest and adds optimal loading.
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In 2019, a new method that removed ice entered the discussion: P.E.A.C.E. (protection, elevation, avoid anti-inflammatory drugs, compression and education) and L.O.V.E. (load, optimism, vascularization and exercise).
Traditional cold therapy has been a tried-and-true way to reduce swelling in an acute injury. Wang and Ni’s article suggests that ice is beneficial in numbing pain and reducing swelling, as it decreases the production of the highly inflammatory molecule prostaglandin E2.
However, cold therapy can delay the natural healing process and potentially cause tissue death or permanent nerve or neuromuscular damage if not monitored properly. With this evidence, ice is now recommended for immediate, short-term treatment for acute injuries rather than for long-term recovery.
Other recovery methods
Wang and Ni also mention a new form of therapy called hyperbaric gaseous cryotherapy, or neurocryostimulation. This method, developed in 1993, utilizes CO2 microcrystals at a negative temperature of 78 degrees Celsius to apply cold pressure to the injury and create the physiological response of “thermal shock,” which may promote analgesic, anti-inflammatory, vasomotor and muscle relaxing effects.
Neurocryostimulation might quicken recovery and healing, but the evidence of this therapy is low and needs to be studied more.
An article by The Sport Journal, published in 2020, and another by Verywell Health in 2021 conclude that extended periods of rest cannot beat the benefits of pain-free movement.
Here are other acronyms that Verywell Health suggests:
M.I.C.E.: replaces rest with movement (stretching, etc.)
M.E.T.H.: movement, elevation, traction (a professional gently pulling on injured area) and heat (moderate heat for 30 minutes maximum)
M.O.V.E.: movement, options for rehabilitation and training, vary activity and ease back into activity
For long-term injury, suggested by various sites:
M.E.A.T.: movement, exercise, analgesics and therapy/treatment
- Movement: pain-free range of motion, light stretching
- Exercise: exercises tailored to the injury to restore strength, flexibility and endurance
- Analgesics: medicines to help with pain, which can be non-steroidal anti-inflammatory drugs (NSAIDs) depending on severity
- Therapy/treatment: physical/occupational/temperature therapy, dry needling, massage, cold and heat packs, neuromuscular re-education techniques
Jane Dimel is a contributing writer at CityScene Media Group. Feedback welcome at feedback@cityscenemediagroup.com.
