[tpoacher]

This is a weird article / statement. RICE, afaik (former doctor here), was never about prolonged use for healing. The intent is to mitigate the harms of the initial excessive inflammation/swelling response (which threatens to compromise tissue at the peak of the injury event), by dampening this response via cooling / constriction of blood vessels.

But, absolutely, after this has settled a bit, you're supposed to apply warmth, not heat, to encourage increased perfusion to the area and promote healing.

So, apples/oranges. There's nothing in the statement above to say that RICE is contraindicated as an initial management, and the implication that RICE was meant to be applied past initial management simply isn't true in the first place (afaik).

I could be wrong as to how others used it, however. I wouldn't put it past a hospital to mindlessly make it a protocol that would then be followed blindly, I guess...

[mb7733]

As a patient, in the past I've absolutely been directed to ice injuries for weeks. (Not so much in the last ~10 years, as the world caught up to the fact that this was a bad idea.) Sources like the Red Cross or WebMD article on RICE[0] _still_ recommend it for at least 48 hours after a minor injury, even though this has been debunked.

So I think it's good that the Wikipedia article emphasizes that the protocol is outdated.

[0] https://www.webmd.com/first-aid/rice-method-injuries

[Cthulhu_]

Last time I had anything like that (tooth removal) they said two hours tops, after that it won't make much of a difference for the swelling anymore.

[zby]

I had a knee injury just this February and I was instructed to cool my knee with ice for weeks (I don't think they meant it constantly - but at least from time to time).

[lr4444lr]

Aside from tissue necrosis or nerve damage due to extreme compression, (which seem to be situations where you'd be at an ER or urgent care anyway due to the severity that entails) what other harms need mitigation? It seems that ice is recommended for every minor or moderate injury handled purely at home.

[tpoacher]

Well, I don't know; an educated guess is that it's not just blood vessels that could be compromised by excessive swelling, however localised.

Having said that, the RICE acronym is often extended to PRICE, to indicate that the typical treatment also involves a "Plaster of Paris". So in the presence of a plaster, the confinement is even more strict, so you would want to control the swelling response inside the tightly-fitting plaster anyway.

But, again, disclaimer, haven't practiced in years, and even then I was not specifically an orthopedic doctor. :)

[slibhb]

RICE is widely recommended to athletes to heal injuries by doctors, PTs, etc.

[iamacyborg]

Ice is also widely recommended to aid recovery for athletes, despite it having a negative effect on post-exercise adaptation. People widely recommend incorrect stuff to athletes all the time.

[Swizec]

Ice is good for muscle recovery immediately after strenuous activity. Within minutes is best, up to an hour or so is still effective. After that you need warmth.

Strenuous here means lifting your one rep max, running 20 miles, breaking a personal best sprint time, that sort of thing.

I can attest from personal experience that ice bath right after exercise works in these cases. I’ve even tested it by icing just one leg and not the other. There is a marked difference in recovery by next day.

Ideally you ice the muscles right after workout then put them in a compression clothing so they’re extra warm for the next several hours.

[sritchie]

I think the idea is that you performed the exercise to create stress that you want your body to respond to by getting stronger / more aerobically fit etc in some way. So by icing, yes, you recover better, but by reducing the stress you reduce the adaptations.

Imagine you could perfectly recover with some intervention. Then weight lifting no longer works!

For examples like the ones you listed, peak performances where you’re not concerned about gainz and maybe even have to perform again soon after, it makes a lot of sense to do anything to recover quickly.

[blastro]

I find I need two different modes:

- hypertrophy to actually gain strength and muscle (ie. longer recovery time)

- maximum recovery to heal from a strenuous exercise and be ready for more the next day (ie. shortest possible recovery time)

In the second scenario, I don't care about gaining strength at all, and the recovery is the only important aspect.

[iamacyborg]

Yep, this is exactly the point I was getting to.

The stress response is literally the point of working out, you won’t get adaptation without stress.

Sometimes that’s undesirable, ie if you’re in the middle of a competitive league and need to reduce stress post-game. In which case, ice away.

[Swizec]

> and maybe even have to perform again soon after, it makes a lot of sense to do anything to recover quickly

For running specifically I’m not trying to make my legs stronger, I’m improving cardio. I need the legs to be in good shape for tomorrow’s hard run :)

[iamacyborg]

In running specifically you need the stress to drive adaptation in the muscle such as capillarisation.

If you’re icing after you run you’re missing out on the benefits of the run.

[bunderbunder]

The article's kind of confusingly written (not exactly unusual for articles on any wiki), but it does indicate in the 2nd paragraph that RICE is no longer indicated for the promotion of healing. It does cite several articles suggesting that, while it can reduce pain and swelling, this is not associated with faster healing.

I'm no physician, but as a child I did spend many Saturday afternoons watching Dad prepare lecture materials for the med school classes he occasionally taught, so I think that I am probably as qualified as a non-physician can be to massively overestimate my own competence. And I certainly don't know anything about soft tissue injury and inflammation beyond what my physical therapist has told me. But in the classes on research methods that I took in grad school, we loved to pick on the mid-to-late 20th century medical literature and standards of care, and one of the common themes that cropped up was a tendency to over-extrapolate.[1] That might be part of what happened with RICE? A strong acute histamine response might be associated with some secondary cellular damage at the injury site, but that's not necessarily a bad thing for long-term outcomes.

[1]: This tendency was deliciously satirized in https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001541/

[bilsbie]

Who’s to say the initial inflammation is excessive though?

Isn’t it possible that promotes healing? The body should know how to heal.

[willsmith72]

When people talk about ice bath recovery, is that strictly for immediately post-exercise then? As in, within 10 minutes?

How does this all relate to sauna to ice bath hot-cold style treatment? Is that a totally different kettle of fish?

[harimau777]

Does that mean that alternating hot and cold is no longer recommended for long term healing?

[davidmurdoch]

He's saying it never was

[h0h0h0h0111]

It's not mentioned here, but at some point there were studies suggesting that alternating heat and cold gave improved recovery over cold (ofc now we know that cold is debunked, the question is whether heat and cold improves recovery over doing nothing or adding heat)

[QuadrupleA]

How is the initial swelling dangerous / compromising?

[tpoacher]

It's been years since I've practiced, so take my understanding with a grain of salt, but, the idea is that the swelling will be excessive, and because the space to accommodate it is limited, this can end up constricting the blood vessels and compromise blood perfusion, despite the fact that the inflammatory response is trying to 'open' them.

Therefore by artificially causing them to open slightly less, you control the swelling, and stop it from pooling so much that it then blocks blood flow completely.

The extreme scenario of this is called compartment syndrome, where the blood flow is completely blocked, leading to necrosis of the affected area; this is an orthopedic emergency, where 'fasciectomy' needs to be performed; effectively slicing open the compartments to allow the expansion to occur without compromising blood flow.

[dogtorwoof]

Off topic, why did you stop being a doctor?