Rest, Ice, Compression, Elevation. RICE has been the go-to treatment plan for pain and soft tissue athletic injuries since the term was coined in 1978. The method helps relieve pain by stemming inflammation in the RICE'd region. But in March, the man who coined the term announced that suppressing the body’s inflammatory response to exercise may actually delay healing.
“Inflammation is important because it’s the first stage of healing,” Dr. Gabe Mirkin says. Icing blocks one of the hormones that show up early in the process to trigger the inflammatory response. “The penalty isn’t permanent—it’s not that you’re not going to heal if you use RICE, but the data is now showing you can delay healing by half a day.”
Mirkin’s announcement came years after physical therapists and scientists had nixed cryotherapy as an effective tool in managing soft tissue injuries. Dr. Tom Kaminski told Men’s Journal that inflammation aids healing in 2013. He’s the director of athletic training education at the University of Delaware, and lead author of a 2013 National Athletic Trainers’ Association position statement on ankle sprain treatment. "We don't want to interrupt that," Kaminski said. Mirkin’s recent renouncement appears to be the final blow(torch) to the ice—and the rest of the four-part protocol.
So should you stop icing to relieve soreness? Not exactly.
For non-competitive athletes, using RICE to manage pain is just fine, Mirkin says. Delaying the recovery by half a day isn’t that significant. But competitive athletes who must return to play as quickly as possible “should not be using anti-inflammatories, should not be using ice, and certainly should not be resting, or only resting for 24 hours," says Mirkin. "You’ll increase healing by movement without pressure.” In other words, if your legs hurt from running, don’t kick back on the couch; go for a stroll or spin easy to keep your blood and its healing agents flowing to your damaged muscles.
Another major caveat: Like RICE, anti-inflammatories will delay healing. But studies show that unlike RICE, the penalty for using them can be long lasting. In fact, despite their name, anti-inflammatories can actually amp up exercise-induced inflammation to the point where it may damage tissues instead of repairing them, blocking adaptations to training.
“Chronic ibuprofen users have some cell damage in their intestines, especially their colon,” says Dr. David Nieman, a professor of health and exercise science at Appalachian State University and author of several studies on ibuprofen use in endurance athletes. “That allows bacteria to escape in small amounts into the blood stream,” augmenting the inflammatory response.
Instead of popping pills, Nieman says, the best way to avoid excess inflammation and soreness during endurance exercise and racing is to fuel properly. Eat carbs, preferably 30 to 60 grams an hour, or half a banana every 15 to 30 minutes. “Keeping the carbohydrate intake going during long events attenuates inflammation during the race, and of course allows you to keep going longer.”
When you’re not out training, he recommends eating plenty of fruits and veggies for their flavonoids, or the substances that give plants their color. “Tissues with high levels of flavonoids can help the body protect against the inflammation and oxidative stress all of us go through all of the time just being living, breathing humans,” Nieman says. In other words, “It’ll help make your body’s natural defenses a bit better.”
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