“Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.”—Dr. Gabe Mirkin
Common injury prevention and rehabilitation techniques strongly utilize and prefer a method of treatment called R.I.C.E. Coined by Dr. Gabe Mirkin in 1978, R.I.C.E stands for Rest, Ice, Compression, and Elevation. This series of treatments is utilized for a multitude of general and severe muscular and training related injuries or ailments. With recent research and testing however, this formerly common and accepted mode of injury treatment and prevention has begun to see an increasingly reduced usage (Stone, 2014).
“Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.” Stated by Dr. Mirkin’s, new scientific research details that icing is not only a poor method for injury prevention, but may also have negative effects on overall athlete injury rehabilitation. When a muscle is damaged or injured through exercise or other means, the human body utilizes natural biological systems to immediately begin repairing the damaged muscle.
The first stage of this process is called inflammation. Counter to classical views, inflammation is a positive consequence of injury. Inflammatory cells serve to aid recovery by releasing the hormone, insulin-like growth factor, directly into the site of muscle injuries. This vital hormone promotes muscle recovery within the specific site of the injury. When ice is used, this critically important biological process is slowed or altogether halted. Instead of optimally promoting blood flow, icing constricts blood vessels and limits the access of inflammatory cells to the site of an injury. Consequently, icing an injury may directly cause a delayed recovery and an increased rehabilitation time (Mirkin, MD, 2014).
In direct relation to ice reducing the body’s ability to bring needed inflammatory cells to the site of an injury, ice also inhibits the body’s ability to reduce or prevent swelling. Swelling is the result of the body’s accumulation of blood, debris, and damaged cells at the site of an injured muscle following the inflammatory response. The body’s natural response to swelling is to “evacuate the waste” via the lymphatic system. When an individual uses ice during rehabilitation, the body’s ability to evacuate this waste is greatly diminished (Reinl, Freeze Frame: Are Inflammation and Swelling Friends or Foes?, 2013).
A study published in the “Journal of Strength and Conditioning Research” further corroborated this by noting an increase in “muscle damage markers” following a period of ice application. Further results noted an increase in individual fatigue “72 hours after topical cooling compared with controls.” Overall results suggested a delayed recovery effect extending from the application of ice to damaged muscle areas (Tseng, et al., 2013).
As further noted by Guilhem, et.al, repeated applications of “localized air-pulsed cryotherapy” did not affect overall muscular and neuromuscular recovery. Over a two week trial period, inflammation and local swelling were found to have not been reduced. Additionally stating “Therefore, instead of decreasing edema [swelling] formation and inflammation, localized cryotherapy (even repeatedly applied) more likely only reduces the amount or the rate of the damaged cells.” Although cold and ice therapy may delay the overall effects of intense muscular activity and soreness, it does not effectively reduce or prevent them (Guilhem, et al., 2013).
In addition to icing, any tool or method for injury prevention or rehabilitation which reduces the body’s natural inflammatory response will inevitably inhibit overall recovery. As stated by Dr. Mirkin, this will include, “cortisone-type drugs, pain-relieving medicines, such as non-steroidal anti-inflammatory drugs, and immune suppressants.” Anything which will offset or delay the human body’s natural immune or inflammatory response—such as Advil and Ibuprofen— will delay the overall recovery process (Mirkin, MD, 2014).
As an alternative to methods of rest, ice, compression, and elevation, direct or indirect muscle “activation” should be utilized. By activated the muscles surrounding the injury site, natural biological systems of recovery can be aided. This process works by—
“[Activating] the tired and/or sore muscles (and/or) the muscles surrounding the injured tissue) to initiate the cascade of events that literally works to protect the area from further damage, prevent or retard disuse atrophy, increase circulation, and, ultimately, heal the damaged tissue.”
Non-use of injured muscles will delay an eventual recovery, while conversely, muscle activity will promote a faster eventual recovery. Appropriate muscle activity may take the form of physical activity such as walking, running, or swimming, or stationary activity such as electronic-stimulation or other muscle stimulation machines.(Reinl, Iceless Recovery: Actual Loading Protocols that Worked!, 2013).
In relation to icing and injuries, it is important to note the difference between muscle soreness and an injury. Soreness is caused by general muscle use—is non-serious—and can last up to a few days following an intensive training session. Common soreness can be relieved through rest, recovery workouts, and rehabilitative measures for muscle activation. If an individual claims a muscle is too sore to use, complains of distinct pains, or has soreness which lasts longer than a few days, an injury may be present.
If an athlete experiences pain or severe soreness following intense muscular activity, ice may be used for pain relief. Recommendations of 10 minutes on-10 minutes off are commonly made and may help to reduce overall pain levels. Following any initial pain relief therapy or after a period of six hours, icing will only be detrimental to an athlete and should be avoided (Mirkin, 2015).
In the case of a serious injury, it is critical that a proper diagnosis from an athletic trainer or doctor is immediately sought. Unlike soreness, injuries cannot be properly resolved through rest and basic recovery work. It is important to follow strict professional guidelines for recovery and rehabilitation when dealing with an injury.
Overuse and sport related injuries are increasingly prevalent at every level of athletics. Injuries can play a large role in athlete development and eventual success. Injuries can be static in nature, effecting a single muscle group, or dynamic and continually change and effect multiple muscle groups. In addition, injuries can affect individual athletes for a short duration of a single day, or conversely, affect an athlete for an entire season—even ending the particular season in question.
The key to injuries is a sense of understanding, awareness, and ability to be proactive.
Two injuries common to track and field and sprinting in particular are shin splints and hamstring injuries. As a result of the high impact, high intensity nature of sprinting, increased strain is largely localized on the lower limb muscle groups.
Shin splints, or medial tibial stress syndrome, is a pain—dull or severe—on the inside of the tibia or shin. Shin splints may occur before physical activity, during physical activity, and after physical activity while resting. Pain in the tibial region of the lower body is caused by, “irritation of the periosteum- a saran wrap like covering around [the] bone- or a stress reaction to the underlying bone.” Shin splints are largely the result of identifiable movement and muscular dysfunction. This dysfunction can be acutely seen in the hips, knees, feet, and toes of an athlete. If these individual groups are unbalanced and pointed in a non-linear or outward manner, increased stress will occur through patterns of overactive versus underactive muscle use. In order to correct misalignment and alleviate issues stemming from shin splints, direct treatment and rehabilitative exercises are necessary to oppose the current dichotomy of overactive versus underactive muscle use. Foam rolling, stretching, and strengthening the afflicted regions have shown to equalize muscle usage and diminish pain from shin splints.
It must be noted however, that pain in the tibial region of the lower limbs may also be caused by underlying bone weakness or more severe injuries. In these cases and when proactive treatments are unsuccessful, professional guidance should be sought. Nonetheless, in general, direct treatment and rehabilitative measures should be attempted instead of merely masking the underlying problem through purchasing new shoes or insoles, icing, or complete inactivity (Stone, Shin Splints 101, 2013).
In addition to shin splints, hamstring injuries are a very common ailment amongst track and field sprinters. Hamstrings are one of the largest and most utilized muscle groups in the human body. Hamstrings are maximally employed during top-speed sprinting, but are also heavily used during each component of a training or performance session. Although hamstring injuries may be caused by basic muscle weakness, more common causes relate to physiological and mechanical issues.
Two large issues which cause hamstring injuries are “diminished range of motion in the ankle and [an] anterior tilt of the pelvis.” Diminished range of motion in the ankle relates to an inability of an athlete to properly dorsiflex the ankle during high intensity activity. The result of this inactivity causes a chain of unwanted tightness through the lower limbs and causes undue strain on the hamstring region. An anterior tilt of the pelvis relates to an individual’s hip being physically tilted forward and not in a neutral or linear position. This position is commonly referred to as “butt-out posture.” This position can be commonly caused by lower back tightness, hip flexor tightness or improper mechanical positions while sprinting. Each individual cause will place a correlated increased tightness and strain on the hamstring muscles. Following proper observation and identification of the root cause, rehabilitation should be focused on “pain free movement,” strengthening of the afflicted regions, and a mentored recovery plan by a sponsored athletic trainer (Schexnayder, 2013).