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RICE Protocol:The End of the Ice Age?

RICE Protocol:The End of the Ice Age?

When it comes to treating acute musculoskeletal injuries, the R.I.C.E (Rest, Ice, Compression, Elevation) method has been the preferred protocol for treatment since its origin in 1978. Athlete or not, odds are that you have had R.I.C.E recommended to you by a healthcare provider, a coach, or have implemented the method yourself to address an injury. However, research since the 70’s overwhelmingly suggests that the use of ice and complete rest may DELAY healing instead of helping.

The Problems With R.I.C.E

Why doesn’t R.I.C.E work? Because your body needs and uses inflammation to kickstart the healing process. When you damage tissue through trauma or develop exercise related muscle soreness, you heal by using your immunity. The inflammatory cells, called macrophages, rush to the injured area and release a hormone called IGF-1 (Insulin-like Growth Factor), starting the healing process. The R.I.C.E method, on the other hand, conflicts with the body’s natural healing process addressing acute injury by REDUCING inflammation and decreasing blood flow to the injured tissue. When ice is applied to an injury, it causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation (IGF-1). (Knee Surg Sports Traumatol Arthrosc, published online Feb 23, 2014). This is not only detrimental to the natural healing process, but is also counterproductive to help an injured player return to sport quickly. Current research suggests that the cooling of injured tissue directly interferes with strength, speed, endurance, and coordination In a literature review of over 35 studies the use of cooling for more than 20 minutes resulted in a temporary decrease in strength, speed, power and agility-based running (Sports Med, Nov 28, 2011).


What to Do Instead: Our Recommendation

While icing is outdated and largely ineffective in many instances, there are plenty of effective strategies to manage pain and to aid in the healing process following injury. Immediately following an injury, elevate to use gravity to minimize swelling and seek the advice of a healthcare professional. If cooling is done for pain control purposes, it is acceptable to use for five to ten minutes max as needed. There is little reason to use ice after six to twelve hours following an initial injury. After it is determined that no bones are fractured and that movement will not increase damage, begin light range of motion of the affected area within pain free range and as directed by your healthcare professional. Contracting muscles around an injury site aids the lymphatic system in flushing out swelling in addition to promoting proper scar tissue formation. As you progress through the healing process, pain free movement influences collagen fibers, the framework of your tissues, to correctly and closely align with the muscle fibers. This will help you heal without any restrictions in range of motion. When dealing with minor injuries, you can typically start rehabilitation within the next day or so. Rehab should be framed around the demands of your sport to ensure success upon return and to minimize the chance of reinjury in the future.

Pioneering Your Path to Optimal Health

At Invictus Health and Recovery, our mission is to effectively resolve pain, prevent future injuries, and empower our clients to confidently pursue their health and fitness goals. We are committed to employing the latest research-backed methodologies in our treatments to ensure that each client receives the best possible care tailored to their specific needs. Visit Invictus Health and Recovery to discover how we can support your journey to optimal health and performance. 

Works Cited

Dr. Gabe Mirkin, et al. “Why Ice Delays Recovery.” Dr Gabe Mirkin on Fitness Health and Nutrition, 15 Sept. 2015,

Khoshnevis S;Craik NK;Diller. “Cold-Induced Vasoconstriction May Persist Long after Cooling Ends: An Evaluation of Multiple Cryotherapy Units.” Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, U.S. National Library of Medicine, 23 Feb. 2014,

 Bleakley CM, Costello JT, Glasgow. “Should Athletes Return to Sport after Applying Ice? A Systematic Review of the Effect of Local Cooling on Functional Performance.” Sports Medicine (Auckland, N.Z.), U.S. National Library of Medicine, 1 Jan. 2012,



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