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What should we do with R-I-C-E.

This article is not medical advice neither a call for the action. The purpose of this article is to provide with already existing for 5-7 years information regarding rest, ice, compress, and elevate (RICE) strategies during sprains, strains and bruising while participating in sports activities.

Many parents are choosing activities and sports for their children so they grow healthy individuals, interact with their peers, master sports skills,

and grow in a challenging environment. Children are getting faster and stronger. Kids are happy when they are successful, they win, they feel strong and confident. more complex sports are also associated with injuries, sudden hits or overtraining sometimes lead to soreness, sprains, and strains. Some injuries are minor some are not. We all hear from coach, the parent or even kid while they get hurt that: “ it is swollen - I need ice”, “my family doctor told me to give it some rest”, “my coach/parent told me to ace wrap my sprained ankle” etc. Again, I’m not saying to ignore recommendations, especially while they are coming from a medical professional but consider that, if athletes after professional screening and testing are not being seriously hurt, the old school RICE protocol for minor injuries is outdated and research shows that it can slow down recovery.

“RICE arises from Rest, Ice, Compression, and Elevation. This concept comes from the beginning second half of the 20th century. Gabe Mirkin, M.D., sports doctor coined RICE in his 1978 bestseller, The Sportsmedicine Book. In the four decades since, his memorable protocol—especially the ice and rest components—has become an article of faith among wounded warriors everywhere.

When you damage tissue through trauma or develop muscle soreness by exercising very intensely, you heal by using your immunity, the same biological mechanisms that you use to kill germs. This is called inflammation. When germs get into your body, your immunity sends cells and proteins into the infected area to kill the germs. When muscles and other tissues are damaged, your immunity sends the same inflammatory cells to the damaged tissue to promote healing. The response to both infection and tissue damage is the same. Inflammatory cells rush to injured tissue to start the healing process” (

“Dr. Mirkin has also conceded that ice also delays recovery. The resulting vasoconstriction from cooling, not only reduces tissue oxygenation with necrosis if extreme but inhibits the inflammatory response needed to initiate healing. The release of kinins and cytokines from damaged tissue is meant to increase vascular influx, which brings fibrinogen and platelets for hemostasis, leukocytes, and monocytes to phagocytose necrotic debris, and fibroblasts for collagen and protein synthesis” (

There is tons of evidence confirming that initiating rehabilitation protocol as soon as possible helps to speed up recovery and to help with confidence while returning to sport-specific activities at a high level. Early rehabilitation most of the time starts with the identification of limiting factors like pain, swelling, deficits in strength, range of motion, balance or problems with motor control in the affected area. While pain and initial shock can be treated with ice (ice is a better alternative to NSAIDs if appropriate), early movement is recommended. The athlete should eliminate all injury provocative factors and could be working on low resistance activities, focus on increase pain-free mobility in the affected area, receive manual treatment, modalities or/and may benefit from therapeutic taping.

The best advice would be, if symptoms persist for more than 2 weeks, seek advice from movement professional which could be a sports doctor, physical therapist or chiropractor. Do not self diagnose, do not throw ice or immobilize areas if you do not know (professional diagnosis) what are you dealing with, establish communication line with the medical professional or athletic specialist if you consider your child/athlete to continue do sports competitively or at high intensity.

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