You may have heard of the acronym called “R.I.C.E”. It stands for rest, ice, compression, elevation. It was popularized in the 1970s by Dr. Gabe Mirkin and has been a widely accepted approach for managing acute injuries for several decades. It became a standard recommendation in sports medicine and athletic training circles for treating injuries such as sprains, strains, and bruises.
However, Dr. Mirkin actually renounced his own recommendation of the protocol in 2014. He stated that he no longer believed in the R.I.C.E. protocol as the best approach for treating acute injuries, particularly regarding the use of ice.
Why is ice not the best treatment for an acute injury?
Dr. Mirkin explained that while ice can temporarily reduce pain and swelling, it may also delay healing by restricting blood flow to the injured area and reducing the body's natural inflammatory response. Inflammation is a natural stage of the healing process. It allows for healing and repairing cells to move into the area. It is a problem only if it is prolonged or excessive. Dr. Mirkin suggested that instead of using ice, a more effective approach might involve allowing the body's natural healing mechanisms to work while minimizing pain and inflammation through other means.
What should be used instead of R.I.C.E.?
P.E.A.C.E. and L.O.V.E. are the newer alternative protocols for managing acute injuries. These focus on allowing the body’s amazing and natural healing process to do its job, while supporting it with early movement and rehab.
Here's what P.E.A.C.E. and L.O.V.E. stand for:
P.E.A.C.E.:
Protect: Protect the injured area from further harm. This may involve immobilization or using supportive devices like braces or slings.
Elevate: Elevate the injured limb or area to reduce swelling and promote drainage of excess fluid.
Avoid Anti-inflammatory Modalities: Unlike the traditional PRICE protocol, which includes ice (cold therapy) as a standard component, the P.E.A.C.E. protocol suggests avoiding anti-inflammatory modalities like ice, as they may interfere with the body's natural healing processes.
Compress: Apply compression to the injured area using an elastic bandage or wrap. Compression helps reduce swelling and provides support to the injured tissue.
Educate: Provide education about the injury, including expected recovery times, activity modifications, and strategies to promote healing.
L.O.V.E.:
Load: Gradually introduce controlled movement and loading to the injured area to stimulate tissue healing and prevent muscle atrophy and joint stiffness. This may involve gentle exercises, stretching, or functional movements, depending on the nature of the injury.
Optimism: Maintain a positive outlook and mindset throughout the recovery process, as psychological factors can influence healing and rehabilitation outcomes.
Vascularization: Encourage blood flow to the injured area through gentle movement like cardiovascular exercise, massage, and other techniques that promote circulation. Improved blood flow can facilitate the delivery of oxygen and nutrients to the injured tissues, which is essential for healing.
I love these protocols because they focus on a balance between symptom management and early movement which has been shown over and over again to be most beneficial in many scenarios.
I hope this was helpful! And as always, I encourage you to reach out to me or a trusted local performance physical therapist to help guide you through your rehab process.
Let’s talk soon,
Dr. Sieara
828-808-3704
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