Updated: Nov 27, 2019
Need help with arm care? I am running arm care programs for players 12U-16U over the winter leading up to tryouts and the season.
One of the most common injury recovery protocols in the United States - RICE: Rest, Ice, Compression, Elevation - is no longer cool...
We now know RICE, ice, and cryotherapy actually inhibit the natural healing process by limiting circulation and reducing muscle activity. The result can exacerbate injury and discomfort, further damage healthy tissue, and delay an athletes return to full strength. Yikes!
The science against icing is becoming so strong that the Harvard-trained MD who popularized RICE has publicly recanted his original claims and written the foreword to a book titled "ICED! The Illusionary Treatment Option". The medical community is now embracing more active recovery and treatment programs that include activating the injured tissue, improving circulation, and dramatically improving recovery times for top athletes.
Recommended Reading: Gary Reinl - The Cold Hard Facts
Listening - "To Ice or Not to Ice?" Elite Baseball Development Podcast
" I liken the use of ice for pain control to the sympathetic bartender that gives [someone] a drink so they can temporarily feel better. Is the problem fixed? No. Did you make things worse? Probably." - Cold Hard Facts, 5.
So...Why did Icing Become Popular?
According to Reinl and other sources, the RICE myth grew out of the first ever replantation of a human arm after a young boy lost his in a train accident. The ice was used to preserve the tissue in the severed limb, compression and elevation used to prevent bleeding out. (Source)
The "RICE is nice" moniker was popularized by Harvard trained MD Gabe Mirkin in the late 1970's. Over the next 40 years, RICE became the go-to treatment for athletes and civilians dealing with mild to moderate acute injuries. Common myths around icing include that it reduces inflammation, reduces pain, and improves recovery. (Cold Hard Facts, 2)
While it is true that ice CAN temporarily relieve pain by calming nerve irritation, overwhelming evidence now suggests that the RICE protocol is actually counter productive...that it actually damages tissue and slows healing.
The Science of Healing
It is important to start with the difference between inflammation and painful swelling: Inflammation is fluid delivered to a damaged area as part of our body's natural, three-step recovery response. In a properly functioning body, the 3 step healing process includes: inflammation, recovery, remodel; aka inflammation, proliferation, maturation. The fluid flushes out damaged tissue and delivers new material the needed to repair and rebuild damaged tissue. (Cold Hard Facts, 2; To Ice or Not to Ice?, 59:00). Swelling is the painful accumulation of inflammatory fluid when it is not evacuated from an area - critically, the body will continue delivering inflammatory fluid to an effort until the damage is healed. This means ice can actually increase total inflammation by delaying the healing process. (Cold Hard Facts, 2).
A lesser-known component of healing damaged tissue is the lymphatic system. To briefly over-simplify: It is a passive system in our body that processes waste. Waste only enters this system when it is forced there by circulating fluids and muscular movement. We cannot process waste from damaged tissue any other way (Cold Hard Facts, 3).
Circulation is critical throughout this whole process. It delivers inflammatory fluid and contributes to flushing waste out of the damaged area. If nothing else, any recovery protocol should promote circulation in an injured area.
The Negative Effects of RICE
RICE is an almost perfect foil for the natural healing process in multiple ways:
- Impedes nerve signals that trigger healing
- DELAYS, not prevents, inflammation, which is step one to recovery
- Reduces circulation: delays inflammatory response and slows the removal of waste
- Limits movement: muscle activation is critical to flushing waste and rebuilding and reorganizing damaged tissue for functional strength
- Cause additional tissue damage through freezing, suffocation, congestion, and atrophy
- Can reverse the flow of waste and pull it back into damaged tissue from lymphatic system
Smart Arm Care & Recovery Protocols
If we were to design a recover protocol from scratch, we would allow the natural inflammatory response, facilitate the flushing of waste, and promote the recovery and rebuilding of healthy tissue. To put it simply - "there can be inflammation without healing, but no healing without inflammation", and "anything that preserves and regenerates tissue" is helpful for recovery (To Ice or Not to Ice?, 59:30-1:04:30).
Using a young pitcher as an example, how would we build a smart recovery protocol that does not include RICE? Let's say this pitcher gets sore after each outing, but does not have any acute injury. Under supervision from a training professional...
- Encourage movement and use of the sore area with light throwing, band work, and other athletic movement. Go play basketball or swim!
- Promote the natural healing response by hydrating properly and eating good food that fuels rebuilding tissue
- Monitor workload to promote health and growth. Maintain a schedule that allows time for rest, conditioning, and building strength in the area