4 Reasons to Not Do R.I.C.E Treatment for Your Sprain or Strain (and What to Do Instead)

Picture the heady days of early 2020. We were all still blissfully ignorant of what was soon to come, and I was out shooting hoops with some friends.

As I was going up for a jumper, my friend tried to block me. In the process, he landed on his foot directly beneath me.

I ended up severely twisting my ankle, and you know how that story goes...

The sensible thing to do next was to get my buddies to help me home and immediately start R.I.C.E treatment, right?

It’s what tons of PT’s, personal trainers, and anyone involved in sports would recommend, after all.

But I do things a little differently. Instead of just following tradition, my approach is backed by research.

What is R.I.C.E Treatment?

R.I.C.E. is a popular treatment protocol intended to help heal strains and sprains. It’s been commonly prescribed by MDs and other practitioners since first appearing in Sports Medicine Book by Dr. Gabe Mirkin in 1978.

R.I.C.E stands for:

Rest
Ice
Compression
Elevation

Let’s take a look at each element and its intended result.

Rest

No big surprises here. The rest element calls for keeping the injured area completely still to allow it to heal.

Ice

When a tendon, muscle, ligament, or nerve gets injured in some way it becomes inflamed.

R.I.C.E calls for applying ice to the injury for a set duration, and then periodically thereafter. Icing causes vasoconstriction, which means the narrowing of the blood vessels. It prevents further inflammation.

Compression

After a sprain or strain, the body floods the area with white blood cells and fluid to start working on the damage.

Compression calls for firmly wrapping the injury in a bandage, compression sleeve, brace, or similar.

Compression encourages excess fluid to leave the affected area quickly, allowing it to move more easily.

Elevation

Elevation is also intended to reduce swelling, but using gravity. The aim of raising the injury is to drain excess fluid back towards the heart via the lymphatic system so that it can be expelled as gas when you exhale.

4 Reasons Not to Do R.I.C.E Treatment

R.I.C.E. treatment is not inherently wrong. It can be useful in some cases.

But for the majority of minor sprains and strains, and in chronic conditions, it can do more harm than good. Here’s why:

1. It can cause muscle atrophy

Muscle atrophy means the wasting or loss of muscle tissue. You lose a significant amount of your muscle mass when completely resting an area.

A recent study found that “In a 23-day program of [bed rest and limb suspension], muscle mass was seen to reduce by 5.2% within the first 2 weeks and subjects lost in total 10 % of quadriceps muscle mass”.

If your muscles shrink, you’re at greater risk of complications and accidents from weakness and lower mobility.

So immobilizing an injured area actually causes a much longer recovery period than staying active.

2. It makes the injured area stiffer

Like muscle atrophy, completely resting the area causes it to become stiffer through lack of use.

Think about what happens to the chain when you leave your bike untouched in the yard for weeks on end...it puts in a few complaints when you suddenly try to use it again!

The longer it takes to begin using the affected area normally again, the higher the risk of stiffness and muscle mass loss. A vicious cycle.

3. It makes recovery time longer

Muscle atrophy and joint stiffness caused by prolonged rest increase recovery time dramatically. But there is also evidence that ice treatment delays recovery too.

When an injury occurs, the area actually needs inflammation to heal, which icing works to prevent.

Icing has also been shown to promote further swelling by causing lymphatic fluids to flow the wrong way. And more swelling means more pain and stiffness and...you guessed it, a longer recovery period.

4. There is no evidence that elevation helps recovery

Recent research concludes that there is no evidence elevating sprains and strains aids recovery. So, there is no justification for prioritizing it over another, proven treatment method.

Its only real use is psychological - it gives a placebo effect.

What to do instead of R.I.C.E.

I’ve spent a good portion of my life doing some form of sport and have had my fair share of injuries, sprains, and strains.

Before I knew better, I did what everyone else was doing and what doctors prescribed: R.I.C.E., movement aids, like crutches, and plenty more rest on top of R.I.C.E to boot.

The result? My body became stiffer and harder to move and I actually lost confidence in returning to sport again.

I stopped trusting the injured area to be able to tolerate weight or any stress at all, even after it was mostly recovered.

And that meant it took months to get back to my sports or even being able to move and function in the way I could before.

As a doctor of physical therapy & orthopedic clinical specialist, I learned how to recovery from typical sprains and strains much faster & more effectively.

After I sprained my ankle, I immediately started walking around, which keeps a light load on the ankle.

I got myself to the gym. I braced up my ankle and started loading the area sensibly.

I knocked out some single-leg squats, lunges, and balance variations that were comfortable for my body.

Within 60 minutes I was able to jog and hop lightly. And within 2-3 weeks, I was back on the court shooting hoops.

My personal example and plenty of research back early mobilization, loading, and moving through a full range of motion for acute injuries.

So let’s look at what that actually looks like:

Rest...but not as you know it

Let’s talk about relative rest versus absolute rest.

R.I.C.E. advocates for absolute rest. This means completely immobilizing the area so it is not moved, stressed, or loaded in any way. As we’ve already learned, absolute rest is seriously counterproductive.

Relative rest means adapting your usual movement in that area so that it is lighter and less stressful than it normally would be. But you still tackle a doable volume of load, range of motion, and stress to the area.

For example, if you are a runner, don’t attempt a 10k with a sprained ankle, but don’t lie in bed for a month either.

A great rehab option in this example would be to practice some assisted single-leg balance exercises, and keep walking if possible.

Then start loading up the ankle, progressing to tolerate weight, as your body allows.

Find alternative exercises

As highlighted earlier, it’s crucial to keep active when injured to speed up the healing process. But you still need to put some thought into how to do that without causing further injury.

One way to do this is to find alternative exercises that keep your other muscles and joints active, particularly those which directly support the injured area while allowing your injury to heal.

Our runner in the example above could switch out jogging for the recumbent exercise bike during recovery.

Introduce light load

Using a light load (i.e. weight in addition to your body weight) in the affected area helps rehabilitate it.

A recent study supports exercising an area that was previously subject to trauma to speed up healing.

What counts as ‘light load’ will vary from person to person. At the very least it should be a weight that introduces a bit of challenge but is still comfortable during the recovery process.

Using your body weight only will take you so far, but a light load will get you there faster.

Seek out a physical therapist

Early mobilization, loading, and moving through a full range of motion is the best rehabilitation for acute sprains and strains.

But when self-treating it can be difficult to know whether you can, or should, push yourself a little further to speed up recovery or whether that would cause further injury.

The best thing to do is seek out a physical therapist as soon as you’re injured. They can fully assess your injury and guide you through the recovery process in a safe way.

A PT will help you get you back to being fully active more quickly than R.I.C.E., medication, imaging, or any other treatment typically linked with sprains or strains.

The problem is, not all physical therapists are made equal. Check out our handy guide to know what to look for in a good physical therapist before you start your search.

Should you ever use R.I.C.E?

There are some cases of injury which need immediate immobilization:

You felt a pop in a muscle or tendon
You cannot move a limb at all
Putting any weight on the area is completely debilitating (i.e. there is pinpoint tenderness in the injured area and you can’t tolerate walking more than four steps)
You feel a mass or ball of muscle in the injured area

These circumstances indicate severe injury. If any of these are true for you, immediately immobilize the area and seek medical attention as quickly as possible. The injury may need surgery.

For acute sprains and strains, R.I.C.E. treatment has more drawbacks than benefits. But compression is debatable.

In my own experience with patients, using a compression bandage or brace on the injured area can sometimes help the patient feel more confident in moving through a full range of motion.

Compression can help lower the perception of threat to the injury by making it feel more supported.

So, compression can sometimes be useful for a patient who is fearful of exercising with a sprain or strain. But I would only recommend it for short-term use.

What variations of R.I.C.E should I be aware of?

Another term you may see online is P.R.I.C.E., with the P standing for ‘protection’.

Slings, splints, and tape are commonly advised for this step. As with the other steps, I would only recommend protection in cases of serious injury.

Overprotecting an area has a psychological impact. It tells your brain that your environment is threatening.

This leads to using protective measures for much longer than necessary and increases recovery time.

It also causes you to overuse uninjured limbs, risking injury to them too.

Following current research, and in my extensive experience in treating acute, sub-acute, and chronic injuries, R.I.C.E. is rarely necessary.

Where there is a serious injury it can be useful in the immediate aftermath, with medical attention following as soon as possible.

For non-critical sprains and strains, the first thing to do is not panic. Early mobilization, a light volume of strength training, and loading the injured area is the quickest route to recovery.

If you need help with an injury, whether it’s new or not, we can help.

Book your free pain relief strategy session today and you’ll leave the call with a clear roadmap to recovery.

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