RICE method is outdated yet it is still recommended. What to do instead.
But even newer protocols do not discuss these very useful add-ins.
Spring and summer mean being more active, which means more injuries and muscle soreness.
Many years ago, when I was training to race at an elite endurance level, I tore my posterior tibialis tendon during a training run, which required surgeries and non-weight bearing for almost a year.
I never fully recovered, nor did I ever get to run a 100 miler. I followed the RICE protocol as prescribed by the PT and the podiatrist. Looking back, I think I did further harm.
No one ever told me about all the beneficial nutrients, herbs, and other remedies that could have promoted healing and recovery.
RICE is Outdated
Dr. Gabe Mirkin introduced RICE (rest, ice, compression, elevation) in 1978 in The Sports Medicine Book. Mirkin’s RICE method became the standard treatment for soft tissue injuries. This protocol was believed to reduce pain and inflammation and promote healing.
In a Google search, I found many links on the first page touting the RICE method still in 2024, even though Dr. Mirkin recanted his original position on the RICE protocol in 2015.
Gary Reinl challenged Mirkin’s RICE protocol in his book Iced, the Illusionary Treatment Option, published in 2013. In the book, Reinl cites numerous studies and anatomical research to support the notion that not only is the RICE approach ineffective, but it may also result in further damage to the affected tissue.
Here is a link to a post by Mirkin in which he admits his RICE protocol is wrong.
Why You Should Avoid the RICE Protocol
(the source for much of the information below is here)
I am baffled that health professionals still follow the RICE protocol. The rest, ice, compression, and elevation method has never made much sense to me since acute inflammation is a positive reaction that we should not hinder. However, it aligns with a modern medicine approach to suppress the immune system.
I argued with a physical therapist friend years ago about RICE, even when data already proved the method was outdated, but she refused to believe any of it and said she used the RICE method all the time with her clients.
Her inability to look at newer research is why you, the patient/client, must stay informed. Your care may end up in the hands of someone who inadvertently does not help you and may even hinder your healing process.
A quick online search can confuse matters since sites such as the Mayo Clinic and Johns Hopkins Medicine encourage ice 4 to 8 times daily for the first 48 hours after an injury. John Hopkins also warns against heat for 48 hours after an injury.
Rest
The lymphatic system is responsible for draining the accumulation of waste products from the damaged site, and to do so, movement is required. Periods of non-movement will result in metabolic waste becoming congested. Therefore, not moving and lying in bed for several days can result in the inability to progress to repair and remodeling processes. Also, resting for more than two days can decrease muscle strength and range of motion.
Ice and Compression
Ice and compression have been shown to delay healing by reducing blood flow and circulation to the injury site.
Further research indicated that ice and compression did not reduce swelling or improve ankle sprain function. Applying ice to an injury may set you back since ice can increase the local swelling and pressure, leading to greater pain.
There is no evidence to support using compression, such as a compression sleeve, for an ankle injury or compression with ice. Too much compression can reduce circulation.
Elevation
Elevation has been used to reduce swelling, but again, no evidence supports its benefits, such as enhancing tissue repair.
In this video, Pam Popper discusses the importance of avoiding the RICE protocol for most injuries and DOMS (delayed-onset muscle soreness).
Swap RICE for This Approach Instead
Reinl proposed the acronym ARITA (active recovery is the answer).
Another acronym used is MEAT (movement, exercise, analgesia treatment).
Movement and exercise as tolerated instead of complete rest are preferable. This approach can assist blood flow to the site and prevent muscle atrophy. Stretching and other gentle range-of-motion exercises or walking (if you can weight-bear) are preferable. How much and what types of movement to incorporate will depend on your injury.
Many people rely on NSAIDs for pain relief, such as ibuprofen, Aleve, Motrin, or Advil. However, an NSAID will NOT promote healing; it will just mask the pain and may delay the recovery process. NSAIDs inhibit the synthesis of prostaglandins, which initiate inflammation. If you need an OTC pain reliever, use Tylenol since it will not disrupt the inflammatory process. Tylenol can damage the liver and gut, so be mindful of its use.
Treatment can include different modalities depending on your injury, such as red laser therapy, acupuncture, ART (active release technique), kinesiology taping, e-stim, and many other options.
Diet Will Play A Role In The Healing Process
Many sources I looked at had acronyms for recovery from an injury that did not mention diet. If you are injured, your diet can promote healing or hinder it, depending on the type of injury and whether your body is currently in chronic inflammation.
Dietary basics include anti-inflammatory foods that also promote healing, such as foods dense in omega-3 EFAs, zinc, and vitamin C.
Consume plenty of quality protein to prevent muscle mass loss and promote healing. For example, your body will require significantly more protein to heal after surgery. Depending on your health and the type of injury, you may require up to 2 grams of protein per kg. An undenatured grass-fed whey protein powder or a bone broth protein powder may be helpful during injury recovery, especially when trying to meet higher protein requirements.
Eat a rainbow of foods rich in phytonutrients, promoting a systemic-wide non-inflammatory response. These foods will not delay the acute inflammation healing process at the injury site. Instead, fruits, vegetables, and leafy greens will enhance immune function and contain the necessary vitamins, minerals, and phytonutrients.
Depending on the type of injury, you may require bone support such as vitamin K2, vitamin D, and food sources of calcium.
To repair cartilage, tendons, or ligaments, drink bone broth (make your own), which contains the building blocks of glycine, proline, and lysine. Some bones will have more cartilage and collagen than other bones. For example, veal bones from calves will contain more than bones sourced from grown cows.
When you cook bone broth, collagenous protein will be broken into gelatin.
There are five types of collagen.
Type I is found in the skin, tendons, ligaments, internal organs, bones, and the vascular system. Type I makes up 90% of the body’s collagen and is found everywhere except in cartilage.
Type II is the cartilage builder. Type III teams up with type I to keep the walls of the arteries and other hollow organs strong and supple.
Hence, you may see that your collagen product is a mix of only type I and type III collagen. A type I and III blend can support hair, skin, and nails, while type II collagen is useful for joints, tendons, and ligaments.
Type IV ensures the health of cell basement membranes and the capillaries' filtration system. Type V is needed for cell surfaces, healthy hair, and the placenta during pregnancy.
Other people may supplement with joint support instead of glucosamine and chondroitin, but these are only two of many needed ingredients for collagen production.
The best option is to make broth in a slow cooker or an instant pot. I am sure there are many online sources, but Fallon Morell’s book, Nourishing Broth, is chock-full of information and recipes.
If you are looking at supplements for injury recovery, it should contain type II collagen.
(Bauman & Friedlander, 2014; Fallon Morell, 2014).
Other Remedies
I will not spend too much time writing on arnica and DMSO. Go to this post to learn more about these powerful remedies.
Arnica can help reduce swelling and inflammation as a topical ointment oil, cream, or homeopathic remedy. Mountain Rose Herbs (www.mountainroseherbs.com) sells arnica oil.
DMSO applied topically can be helpful for pain, swelling, and healing of soft tissue, ligaments, and tendons. In the case of an injury, you may want to add ingredients such as vitamin C and magnesium to the DMSO.
Comfrey leaves, and roots contain healing properties, and they are one of my favorite remedies. The comfrey “scare” occurred in the late 1980s when reports about comfrey toxicity started to pop up. There are concerns over a class of alkaloids known as pyrrolizidine alkaloids (PAs). The root contains about 0.3%, and the leaf contains about 0.15%. The fear was that PAs could cause liver disease.
The dangers of comfrey are based on two case studies and rodents' highly concentrated purified PA consumption.
Because of this, comfrey was banned for internal use. Although the leaves and roots are not easy to locate, they are easy to grow for medicinal purposes. A local herb shop is probably your best resource.
The dried leaves for tea consumption will only contain traces of PAs since the alkaloids are not water-soluble. However, I do not suggest consuming tea. This information is for informational purposes only; use your judgment and research the plant. Tea should only be used for therapeutic purposes, such as for 4 to 6 weeks, and not consumed long term.
Comfrey root oil is a safe topical option. Either way, it can be helpful for broken bones, sprains, torn ligaments, and other injuries.
Bromelain, an enzyme in pineapple stems, can reduce pain and swelling. Take 500 to 2,000 mg of bromelain away from food in 2 divided doses. Start with the lower dose and gradually work up to the higher dose, only if warranted.
Curcumin is a compound in turmeric that can also reduce pain and inflammation.
If you consume a whole-food diet and bone broth and do not have chronic inflammation, allow the body to do its job, hold off on the supplements, and use only if the pain, inflammation, and swelling are not resolved after applying short-term heat and the protocols mentioned in place of the RICE protocol.
(Bauman & Friedlander, 2014).
Bottom Line
The RICE protocol may delay the healing process. If your physical therapist or doctor tells you to follow the RICE protocol for your injury, ask why and what evidence supports its use for healing and recovery.
Do you consume bone broth? If so, what are your go-to bones? Do you source them locally?
Additional Sources
Bauman, E. & Friedlander, J. (2014). Therapeutic nutrition. Bauman College.
Fallon Morell, S. (2014). Nourishing broth. Grand Central Life & Style.
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Great information! A month or two ago, my knee started bothering me, no known trigger. Certain movements would cause intense pain. After 3 chiro visits, he sent me for an MRI. I came home from the MRI the evening of May 2, read this article and recalled that my husband had been using DMSO (for a skin issue, I think?). I applied it before bed that night and it went a full 4 days without that "gotcha" pain! I've been applying it to my knee with magnesium gel twice a day since, and feel like it is somewhat better. How would I add vitamin C? Is there anything else i should add? I have been using frankincense eo with it. It still grabs me on occasion, but the pain isn't as sharp. The MRI revealed a torn meniscus. I have an appt with the chiro this afternoon, and will give him a link to your article.
I also forwarded it to my nephew whose kids play hockey and told him to follow the links about concussion.
For many years I've been taking a glucosamine/chondroitin/MSM supplement for joint support. It looks like bone broth might be a better choice. Am I understanding you correctly that it contains all five collagen types?
Also, about twenty years ago I started taking tart cherry extract for a nagging lower back pain that was gradually getting worse. It took about two weeks to notice an improvement, and in two more weeks the pain was completely gone. A few times I've run out of it and put off reordering, and the pain starts to come back in a couple of weeks. But once I start taking it again, the pain disappears, and I have no joint mobility issues. Have you heard of using tart cherry extract for arthritis or other joint issues? If so, do you know how it works and what chemistry is involved? Thanks for another interesting informative article.