Most of us have at some point had a sports related soft tissue injury or some other trauma that caused pain and swelling of the area or joint. For decades, the conventional wisdom has long been Rest, Ice, Compression, and Elevation (RICE), complete rest of the affected area, continual icing to reduce swelling, heavy compression, and keeping the area elevated. Now though, recent studies are showing that complete rest and continual icing of injuries can actually be detrimental to the healing of injuries, can cause tissue damage, slow healing, and lead to chronic pain. Dr. David Mirkin, the doctor who coined the term RICE in 1978 has recently reversed his stance in the face of new evidence and now recommends against this strategy.
Why is Icing injuries and complete rest of the affected area no longer recommended? The original idea behind icing was to reduce swelling and inflammation of the injured tissue. The use of ice and anti-inflammatory medications will definitely do this, but you really don’t want to. Inflammation is the body’s natural response to injury and consists of five signs. Swelling, Redness, Heat, Pain, and Loss of Function are the body’s way of protecting the injured tissue. All of these signs happen as the body sends a major circulatory increase to the area. The area turns red and gets hot as blood and fluids fill the local tissues causing swelling and loss of function, this is the body’s way of stabilizing the joint and preventing further damage, the pain is there to remind you to take it easy and avoid further injury through usage of the joint. For an injury to heal, our immune system needs to take over and basically clean up and repair the damage that has occurred. Immune cells come in and remove injured and dead cells and tissues, and new cells come into the area to replace them, for this to happen, there needs to be good circulation coming to the affected area. Icing the area or taking anti-inflammatory medications slows this process to a halt, as a result, it takes the body a longer time to remove the damaged cells and tissues and replace them with new healthy ones. Icing can also decrease blood flow so much that surrounding cells lack fresh oxygen and can suffer additional damage resulting in more pain, and possibly in the cases of nerve damage, longer lasting and possibly permanent pain.
Chinese medicine views sports type injuries like this as acute stasis of qi and blood, basically meaning that circulation has stopped and blood has started to accumulate. The Chinese medicine treatment principle is to move the qi and blood in the area and stop the pain. This can be accomplished in a few ways, and it can work best if these are combined. First is acupuncture to increase circulation and reduce pain, acupuncture is clinically proven to have this affect and it can be a great 1st, 2nd or 3rd step to treatment. Often for acute injury, points distal to the area or the areas mirrored image on the body are used so as not to aggravate the area. This can be extremely effective for all types of pain. For example a sprained right wrist may receive left ankle acupuncture. Next is herbal medicine, either internal or external, and sometimes both. Internally, there are herbal formulations full of herbs that move blood and qi and stop pain that are rolled into large honey pills taken for the first few days that are seen as a sort of shotgun approach to increase circulation and stop pain throughout the body. Externally, poultices of herbs are applied directly over the injured area. These herbs are, for acute injuries, often very cooling, analgesic, and have strong circulatory increasing affects, meaning that swelling will be reduced, but circulation will be increased and pain will also be reduced without the dramatic effects of anti-inflammatory medications. These are also often applied under a compression bandage. Finally, Movement therapy or Tui Na Massage can be used to restore function to the injured area. Often times, acute injuries can require more frequent treatment in the beginning, several times a week in some cases for the 1st week, however, these injuries will often heal faster and with no lasting damage to the area than those using the RICE method.
Of course, be sure to get proper medical care if a break is suspected or if there are any open wounds, or heavy bleeding. These are serious injuries that require immediate emergency medical attention at a hospital.
So the next time you have an acute non-emergency injury, think about Chinese Medicine and acupuncture before thinking about Icing and pain medications, it could make all the difference later in life!
For the article by Dr. Mirkin on not using ice, click here
For a great article on why not to use Ice and Anti-Inflammatories for acute injury, click here