Leading Doctor Changes Tune, Says You Shouldn't Ice Injuries or for Recovery

Learn why the doctor who coined the term R.I.C.E. (rest, ice, compression, elevation) now believes ice should be removed from the equation.

R.I.C.E., which stands for Rest, Ice, Compression and Elevation, has been a go-to treatment for sports injuries and muscle soreness for decades. But Gabe Mirkin, the doctor who coined the term, now wants to retract the "I," believing ice is a no-no for athletes.

"We thought that, the more swelling, the longer it would take for an injury to heal," Mirkin said.  "Ice reduces pain and swelling to the injured area. Cooling down decreases blood flow, so we thought that cooling would also limit the amount of cell damage."

Due to a growing body of evidence to the contrary, Dr. Mirkin and his colleagues now believe that icing, as well as too much rest, actually delays recovery for soft tissue injuries. Mirkin recently issued an online retraction in which he cited a 2004 study from the American Journal of Sports Medicine, as well as 21 other studies that evaluated subjects recovering from acute soft-tissue injuries, which found little evidence that ice therapy was effective in promoting recovery.

Several recent studies suggest that icing the affected area interferes with the first part of the healing process, decreasing blood flow, delaying and reducing the amount of healing chemicals.

Similarly, a 2005 article published in the Scandanavian Journal of Medicine and Science in Sports found ice "ineffective in reducing the indirect markers associated with exercise-induced muscle damage and enhancing recovery of muscle function."

A 2013 study by Paris researchers examined the effect of cryotherapy (freezing and thawing of the cells) on the duration of recovery after participants performed strenuous biceps exercises. Certain markers among those who received the cold therapy indicated they were delayed in returning to their normal state and muscular function.

Mirkin now believes that inflammation is a necessary part of the healing process, and any attempt to thwart it only prolongs recovery. He said, "The term inflammation means that your immunity turns on in response to a harmful stimulus to protect the body. The same chemicals you produce when you mobilize your defenses against germs also respond to an injury."

According to Mirkin, the advantage of icing and what likely accounts for its continued prevalence is that it decreases pain. But reducing pain in this manner can come at the expense of overall recovery speed. "For a regular exerciser, delaying healing a day or two is somewhat irrelevant, but for a dedicated athlete, it's a catastrophe," he said. 

Mirkin also suggests that ice has the potential to adversely affect performance. He noted another study from the Journal of Sports Medicine in 2012, which found that icing negatively impacts speed, strength, power and agility following cooling.

Instead of icing, the best way to promote healing, according to Mirkin, is to engage in active recovery with bouts of easy movement, such as short sessions on a stationary bike. He said, "You might want to rest a few hours, but then you should start moving. Just don't add excess pressure to the injury."

Mirkin recommends pedaling slowly until your legs feel heavy or you feel discomfort. After working your way up to 30 minutes per day, incorporate interval workouts every other day.

Obviously if the pain of the injury is too severe to move or pedal, consult a doctor or a sports medicine professional for rehab recommendations. But for common muscle aches and soreness, it might be worth a try to embrace the healing inflammation and get back to exercising. 

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