For over four decades the soft tissue injury treatment protocol was RICE: Rest, Ice, Compression, Elevation. Now we have Peace and Love and Be Calm!
RICE - Rest, Ice, Compression, Elevation
Most people use this acronym and know what it stands for, it has been the gold standard treatment after a soft tissue injury for ages. But what is it based on, is it even the best method and the go-to protocol post injury?
RICE was prescribed as injury treatment for pain relief by Gabe Mirkin, doctor, marathon runner, writer (Sportsmedicine) in 1978 and like many things from that era became widely accepted and adopted by the mainstream. The 70s was the era of running, jogging and fitness clubs exploding on the scene, and Mirkin’s timing was perfect to catch the zeitgeist. He also had a platform as a contributor to running magazines, and even his own radio show. Even people who know nothing about sports, injury, medicine or fitness will rush for the ice when they have an injury, stop moving and elevate the injured part.
But not very many people know that RICE is no longer considered the standard treatment for soft tissue injury and even the man who coined the phrase has reversed his stance on that treatment. Mirkin recanted his position in 2015 (so it’s no surprise that it’s still not well known, since the treatment was standard for over 40 years).
It’s always interesting to see where these ideas sprang from in the first place. The germination of a concept that is an accepted fact has its roots in 1962, when a young boy lost an arm in an accident, and resulted in the first successful reattachment surgery in history. The severed arm had been preserved on ice and since this surgery was so famous, certain elements of it became known, repeated and eventually (like a game of broken telephone), retold in ways that slightly changed the narrative until eventually the use of ice became a treatment for every injury. Prior to 1962, ice had never been considered as a soft tissue injury medical treatment! That’s how prevalent it has become in our culture, it seems as if it’s always been around.
It is now known that for most soft tissue injuries, rest and ice is not indicated and although ice may dull pain, it can delay healing, and the jury is still out on compression and elevation. Ice is a vasoconstrictor, it limits blood supply (thereby reducing swelling, which seems like a good thing). But this also limits the rush of immune cells to the injured tissues.
When you think about it, our bodies are pretty smart at healing and taking care of business. Why would we suddenly need ice to help the body after an injury when surely the body’s response has evolved over our timeline! Indeed, the inflammation process is essential for tissue repair; releasing chemicals for the healing process and increasing blood flow to the area, breaking down and removing damaged cells and beginning the rebuilding process.
So what should you do right after a soft tissue injury? Of course this depends on the site, the kind and severity of the injury as well as your physical history and possibly mental state, but a general guide for those minor injuries that befall us all now and again can be as follows. It’s also interesting to note that anti-inflammatories are not recommended and may affect long term healing particularly when high dosages are used.
Peace and Love
P - protect, unload, rest if pain signals are great
E - elevate (weak evidence supports this but its probably not harmful)
A - avoid anti-inflammatories. Inflammation helps repair.
C - compress. Again, the evidence does not support this for all injuries but seems to be helpful for ankle sprain
E - educate. Get info on the condition and management of your injury. This can help avoid unneccesary treatment such as surgery.
L - load. Resume normal actives as soon as symptoms allow.
O - optimism. Staying positive and calm is associated with better outcomes.
V - vascularisation. Resume pain free cardiovascular activity as able to increase blood flow.
E - exercise. Restore mobility, strength and proprioception early after injury.
Another is the the Be Calm Protocol. I’ve been to several lectures by biochemist Rebecca Dietzel. This document is well worth reading (see links below).
B - breathe to calm your nervous system, long slow inhales and exhales, focus on the air moving in and out
E - evaluate. Once you are calm, evaluate the injury to assess if you need medical attention. If it’s a soft tissue injury, continue with the protocol.
C - compression. If the injury is not a fracture, you can use a tensor bandage to gently wrap the area. Wrap a joint in the neutral position.
A - able actions. Move the injured part as much as you can pain free (what you are able). Repeat these actions slowly and often.
L - elevation, use gravity to natural limit swelling by elevating above the heart
M - minimal ice. If pain is intense and breathing doesn’t calm it, 5 mins ice on, 20 mins ice off, 5 mins ice on.