Why the R.I.C.E. Method Doesn't Work

16:28 Unknown 0 Comments

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The R.I.C.E. method, coined by Dr. Gabe Mirkin in his best-selling book The SportsMedicine Book (1978), has been touted as the end-all be-all of muscle injury treatment and recovery methods for the past several decades. R.I.C.E. stands for Rest, Ice, Compression, and Elevation. It is so pervasive that despite current scientific and medical studies showing the detrimental effects this method has on healing, you will still find most doctors and sports professionals recommending it as a viable treatment.

Disclaimer: Always consult a doctor for any serious injuries. This blog is intended for reference/educational purposes, not to diagnose or treat medical conditions. Sources are hyperlinked.

Rest

For the acute stage of injury, rest is important. Continuing to push through your physical task when in pain is ignoring your body's message that something is wrong. Immediately stop what you are doing and take rest. For mild injury this may only be a few minutes, for more severe injury it may be longer. Intense sensation and mild discomfort are normal when building muscle and flexibility, however acute pain is not normal and should be heeded as a warning of injury. Where rest doesn't work is when it is prolonged or excessive unnecessarily. Bed-rest is especially detrimental to recovery as it inhibits circulation among other healing mechanisms in the body. After the initial acute stage of injury, movement and exercise should be introduced slowly to restore proper circulation and blood flow which carries nutrients to the injured tissue and encourages lymphatic drainage of metabolic waste. Movement will also help regain range of movement and prevent scar tissue from building up around the injury. Exercise should be used to start strengthening the muscle again. There is a mental component that comes into play when immobilising the injury for too long. You might experience inhibition in moving the affected area if you wait too long before introducing recovery movements and physical therapy.

Ice

Ice is perhaps the most pervasive injury recovery treatment recommended by professionals today. Let me start by saying this; swelling and inflammation is the bodies natural response to injury. A recent study published by The Journal of The Federation of American Societies for Experimental Biology showed evidence that inflammation is actually beneficial and in fact necessary for tissue recovery. That's because in the study, researchers discovered a hormone being produced in great amounts by inflammatory cells, called insulin-like growth factor 1 or IGF-1 which increases the rate of muscle regeneration and greatly improves muscle repair. Previous ( and current ) opinion of professionals is that reducing swelling encourages healing, however the results of this study contradict that notion. It was found that the application of ice and the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen inhibits the body from delivering this healing hormone (and therefore inhibits proper healing ).

Ice has also been shown to reduce muscle strength, power, and endurance. It affects the way your nerves function and although this may relieve pain temporarily it will affect the healing process greatly. It also constricts blood vessels, restricts blood flow preventing vital nutrients, oxygen, and other healing properties from reaching the area.

According to professionals, Ice can be applied briefly for short periods to manage pain.

Compression and Elevation

Compression and Elevation fall into the same category as Ice. They reduce swelling and blood flow to the injury and therefore should be considered as detrimental to the healing process.

In terms of compression or immobilization, protection should be the main theme here. Focus on protecting the injured area while it heals, this includes removing it from the cause of injury, seeking out proper treatment, and not engaging in any activity that might exacerbate the injury,

The use of NSAID's have also been shown time and again to inhibit healing.

So what IS the best method for recovering from a muscle, tendon, or ligament tissue injury? I have discovered a method called M.E.A.T. that seems to make the most sense. M.E.A.T. stands for:

Movement

As I mentioned above, movement should be introduced after the acute stage of injury when pain and swelling has significantly subsided. movement should be gentle but consistent. Things like gentle stretching have also been shown to be effective. This is as opposed to total immobilization which has been shown to be less effective in long-term healing.

Exercise

Including targeted strengthening exercises will increase blood flow to the affected area, strengthen the muscle, as well as help to prevent build up of scar tissue.

Analgesics

Medication to relieve pain can be administered in moderation, but you should avoid the use of NSAID's especially since prolonged use of these can lead to stomach ulcers and other gastrointestinal stress, not to mention that they have been shown to inhibit muscle repair as stated above. Some people have found the use of Epsom salts or Arnica (homoeopathic treatment) to have healing effects, and some people use topical analgesics to relieve pain.

Treatment

Various treatments that have been shown to be effective in healing muscle/tendon injuries are: massage therapy, taping, acupuncture, alternate ice/heat in short periods during acute phase, and physical therapies.

Remember that in extreme cases for serious tears and injuries one should always consult a doctor. If you are having other symptoms such as fever, vomiting, dizziness, please seek out emergency medical care.

Shoulder Alignment: Injury Prevention 101

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I wanted to write a post on proper shoulder alignment in aerial work as shoulders are THE most susceptible to injury due to their large range of motion and complex structure. In aerial, a lot of pressure is placed on the shoulders continuously and it is all to common for aerialists to have poor posture leading to injuries such as muscle tears, sprains, & pulls, tendonitis, dislocation, weakness, and more. The anatomy of the shoulder, specifically the rotator cuff, is something I believe all aerialists should have at least a basic understanding of in order to help prevent these types of injuries.



As aerialists we are constantly holding our body weight with our shoulders during hangs, climbing, inversions, and twists. In each of these movements we should be aware of where our shoulders are and how they are engaged.

The various movements of the shoulders are as follows:






It is a good idea to practice each type of movement with your arms in different positions (extended overhead, to the side, in the front, and down by your side) so that you fully understand what the movement feels like and how they compare to each other.

For the majority of movements in aerial dance good posture is accomplished by depressing the shoulders down and away from your ears, and also externally rotating. In any movement where we are hanging or pulling with our arms overhead, we should be in this position. If we perform these movements with elevated shoulders we end up unnecessarily engaging all of the muscles in the neck and upper shoulders, which can lead to injury and fatigue in these areas (and instability in the shoulder joint).

For movements where we are inverted and our arms are in front of us, as opposed to overhead, we must make sure our shoulders are retracted. This helps us engage the latissimus dorsi muscle and
in turn, provides us with more shoulder stability in this position.

There are other applications for the different movements and you will learn these as you go, which is why it is important to have an aerial instructor who is familiar with proper shoulder alignment and injury prevention.

Paper Doll Militia has a series of videos called Aerial ABC's that are very informative:

1. Always warm up well! Get your body moving and your heart beating. Your goal here is a couple of things: warm up the body by increasing blood flow to the muscles, prepare body by introducing it to range of movement. You should be doing exercises with your shoulders that take you through the full range of motion. Static stretching is NOT warming up, and can actually lead to an immediate decrease in muscle strength and therefore could set you up for injury. You should be doing brief cardio type movements, as well was dynamic stretches.
2. Stay Hydrated! Drink enough water to feed your cells while you do ANY physical activity, (and in general). A hydrated body is a lubricated body.
3. Remember your posture. Keep your shoulder position in mind throughout your training session. Practice the various movements so you become comfortable with executing them. Ask your instructor if you are unsure about where you shoulders should be in any particular position.
4. STOP IMMEDIATELY if you start to feel pain, numbness, tingling, or extreme fatigue in any joint. Mild discomfort is normal. Pain is not. Pain tells us something is amiss in our bodies, listen to that message.
5. If you do end up with an injury there are things you can do to minimize damage and accelerate healing. You can apply ice briefly to help with pain, however swelling is the body's natural response to injury and is a healthy way for the body to bring blood and other healing components to the affected area. Avoid using the injured joint for at least a couple of days, rest is key. You can also take a NSAID to help with any pain, however these can hurt your stomach and inhibit muscle growth so only take when necessary. Once you are feeling up for it you can start to move the joint around, stretching and warming up, to slowly regain range of movement and promote healing. This will reduce stiffness and the instance of scar tissue. If pain is severe, if the joint looks like it is protruding, or if you feel numbness that does not subside, you should go to a doctor right away.