Approximately 30% of all visits to a primary physician are for musculoskeletal issues, yet training dedicated to musculoskeletal conditions is abysmally low. I had 2 weeks dedicated to musculoskeletal medicine in 4 years of medical school.
That discrepancy aside, I would like to discuss a common misconception. Many of us were taught “RICE” (rest, ice/ibuprofen, compression, and elevation). I hope you’re sitting down, because it is not evidence-based, and furthermore, increasing evidence shows RICE may hamper healing after 48-72 hours.
In 1978, sports medicine specialist Dr. Gabe Mirkin coined the term RICE; however, in 2015, he reversed this, writing that ice “may delay healing, instead of helping.”
Some research indicates that ice delays healing. Several have also proposed that after an injury, an acute inflammatory process begins, with increased blood flow and recruitment of immune cells, neutrophils, and then macrophages. Ice results in vasoconstriction, which may inhibit this response.
The “I” for ibuprofen has also come into question. A Cochrane review concluded that topical NSAIDS may be beneficial for acute pain after a soft tissue injury; however, they note a large amount of unpublished data that may change future recommendations.
Part of the issue with all the recovery devices on the market be it simple compression, sequential compression, elevation, or cryotherapy is that there is a huge placebo effect. A study on the effect of compression socks on recovery confirmed that those who believed the socks would help did better than those who were skeptical.
The first 48 hours after an injury, ice, relative rest, and NSAIDs can help with acute symptoms, swelling, and pain; however, if utilized for longer, they may delay healing. Some have replaced “Rest” for “Movement,” changing the acronym from RICE to MICE. Without acute trauma (broken bones, ruptured tendons, etc.), early mobilization and perhaps heat are likely better to stimulate healing.
Some have taken it a step farther and proposed the acronym MOVE: Movement; Options (cross training and active recovery); Vary rehabilitation; and Ease back into activity.
While evidence is lacking for one-size-fits-all recommendations, we likely need to incorporate more early mobilization, stretching, muscle activation, topical NSAIDS, and heat the first few days after a musculoskeletal injury and re-educate physicians, and patients, to utilize less RICE and more MOVEment.
