In 1978, Gabe Mirkin, MD coined the term RICE (Rest, Ice, Compression, Elevation). Health care practitioners and laypersons alike are quick to recognize RICE as the ‘gold standard’ treatment for acute injury. All of my patients know that in Chinese Medicine we seldom recommend Ice for any injury. Now the very same physician who coined the term RICE, Dr. Gabe Mirkin, is admitting that there is a lack of evidence to support the therapeutic use of Ice.
Dr. Mirkin describes how ice delays healing in his 3/2014 Article, Why Ice Delays Recovery. “Inflammatory cells rush to injured tissue to start the healing process. The inflammatory cells called macrophages release a hormone called Insulin-like growth Factor (IGF-1) into the damaged tissues, which helps muscles and other injured parts to heal. However, applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1.” He goes on to say that, “anything that reduces your immune response will also delay muscle healing. Thus, healing is delayed by: cortisone-type drugs, almost all pain-relieving medicines, such as non-steroidal anti-inflammatory drugs like ibuprofen, immune suppressants that are often used to treat arthritis, cancer or psoriasis, applying cold packs or ice, and anything else that blocks the immune response to injury.”
Why is Ice therapy recommended so often if there is little evidence that it works? Well old habits die hard people, physicians, therapists, and laypersons alike are used to the RICE protocol, and so they continue to use it. The science supports the 3,000 year old Chinese theory that blood flow is the key to health and injury healing. Activities that increase blood flow such as acupuncture, stretching, and exercise improve tissue healing and repair, speeding up healing. Things that that limit blood flow, such steroid and non-steroid anti-inflammatory medications, ice, and compression impair or slow the healing process.
Even the National Athletic Trainer’s Association August 2013 position statement on the management of ankle sprains states that there is “limited” clinical evidence for ice therapy. However, they found stronger evidence that functional rehabilitation, proprioception, and balance exercises improve healing.
So, yes, it seems like “everybody” other than your Acupuncturist recommends ice for injuries. Now you know that “everybody” might not have read the research.
Sources: RICE: The End of an Ice Age, April 4, 2014 by Joshua Stone stoneathleticmedicine.com/2014/04/rice-the-end-of-an-ice-age/ http://www.nata.org/sites/default/files/ankle-sprains.pdf
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