Rest, Ice, Compression, and Elevation (RICE) has been the standard, de facto protocol for traumatic sports injuries and extreme soreness and pain caused by overuse since the late 1970’s. RICE is apparently effective, immediately reducing both pain and soreness and almost everyone does it without thinking. Ice bags held on to the athletes with ACE bandages has been visible on sidelines seemingly since the advent of televised sports. But, what if this was wrong all along?
Most people, particularly athletes, view inflammation as a negative, but like most processes in the body, it serves a purpose effectively. Anytime you have an infection or injury the immune system rushes inflammatory cells to the appropriate area, which fosters the healing response, including signaling a release of Insulin Growth Factor 1 (IGF-1) that allows muscles and other tissues heal.
Since the blood flow is what delivers the inflammatory cells, anything that slows this down impedes the healing process- every single component of the RICE protocol impedes this flow! Once it is understood that inflammation is what spurs healing, it becomes common sense that blood flow is necessary and should be encouraged, which ironically would be the opposite of Rest, Ice, Compression, and Elevation.
Inflammation is good, but the swelling is bad. Swelling (edema) causes pain and can reduce blood flow by increasing pressures around the injury site which constricts blood vessels. Chronic edema can also reduce joint mobility and over time can stiffen the tissues around the area, further complicating matters.
So, the inflammation is good, but the swelling is bad; how do we address both for the most efficient healing and the quickest return to play? Intermittent compression around the injury site with pain-free movement uses compression and movement to pump the excess fluids out, stimulates blood flow and keeps tissues pliable. A common name for this protocol spurred on by the CrossFit movement is “Voodoo Flossing,” and I can testify that it is extremely effective, dramatically reducing swelling, allowing the inflammatory cycle to continue unimpeded and reducing time on the disabled list.
An example of Voodoo Flossing:
Yes, some of you will have a hard time discounting the RICE protocol, and it is still widely touted. If you don’t believe me or this post, click the link below. It is an article calling fault to the RICE protocol, by the man that invented it in the first place! BAM.