End of the RICE age?

I’m a big fan of systems. And often times systems go hand-in-hand with acronyms. Consider for example that SYSTEM is an acronym for save yourself time energy and money.This can help us remember what to do and ensure that something is done the same way each time.

If you played sports growing up there is a good chance you sprained an ankle or had some other type of soft tissue injury at some point. And do you remember what the protocol was for this type of injury?

RICE which stands for rest, ice, compression and elevation was the solution to treating our injury and ensuring recovery. More recently there is some debate as to whether this is still the preferred protocol.

You don’t have to go back many years to when the recommendation for an episode of low back pain was bed rest and ice. Now medical professional will encourage a return to regular activity as soon as it is safe to do so. Which is the opposite of bed rest. Instead the prescription is movement rather than rest.

But what about ice?And where does heat factor into this?

Let’s look at each individually to see what each does for us and come up with a recommended plan for you.


What it does

The application of ice is typically used to control inflammation and does so by constricting blood vessels in the vicinity of the cold. There will also be an analgesic (pain relief) effect from the topical application of ice.

When it may help

Treatment with cold or ice (cryotherapy) may be beneficial after a heavy lifting session, between training sessions or with an acute muscle injury.

How long to use

For an acute joint sprain ice may help in the first 24-48 hours to help reduce inflammation and provide some pain relief. It is important to recognize however that the inflammation response that occurs with injury is part of the repair process and precedes remodelling. So using ice should help to control but not prevent inflammation.

In terms of how long to apply ice this can be for 10-20 minutes at a time. To prevent nerve or skin damage do not apply ice directly to bare skin. Make sure to wrap the ice in a towel or have some barrier between the skin and the ice.

After an ice treatment of up to 20 minutes remove the ice for 30 minutes and then repeat. It appears the recommendation of 20 minutes of ice, and no longer, came as a result of nerve palsies when ice treatments lasted longer than 30 minutes. So err on the side of caution and use treatments less than 20 minutes.


What it does

The application of heat increases circulation to the area of the body where it is applied. It does so by dilating the vessels and increasing blood flow to the area.

When it may help

Heat may help to relax muscles and achy joints. Many people use a bath as a relaxation technique to help pump up the parasympathetic nervous system after a long, stressful day.

Heat can also be helpful for chronic pain such a painful low back that someone has had for years. The application of heat may help to relax and provide relief for those areas of the body that are always tight and sore.

How long to use

As with the application of ice keep heat treatments to 20 minutes or less. The heat should be warm and not hot.

Other factors to consider

When trying to decide whether to apply ice or heat consider the following.


Is the condition being considered acute or chronic? In other words did it just happen or have you lived with this for a while? For acute injuries consider ice application for the first 24-48 hours at no more than 20 minutes at a time.

With chronic injuries, such as the low back pain described above, heat may be more beneficial. If the condition was back spasms for example, the application of ice may worsen the condition as the constricting blood vessels may cause the muscles to contract more worsening the spasms.


The first thing to ask yourself when consider ice or heat is what is the reason? Are you looking to control inflammation (ice)? Or are you looking to reduce stiffness (heat)? This will help you decide which direction to go.


For each treatment type, whether it be ice or heat, keep the following in mind:

* keep treatments to less than 20 minutes

* use caution for individuals with circulatory problems and heart disease

* do not apply heat to damaged muscles, recent injury or bruised areas

* do not apply either treatment directly to the skin

The last thing to mention is to always consult with a medical professional if in doubt.

Training recovery protocol

For athletes looking to recovery more quickly for a subsequent training session the following protocol may help. You can use the same ratio below starting with 1 min heat/30 s cold doses and work up from there.

* 2 min of warm water

* 1 min of cold plunge

* repeat 4-5 x finishing with cold

Chris [fb-like]



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