Breaking The Ice: HEALS Takes On RICE For Injury Recovery

Dan Raynham
May 1, 2022
6 min read

Updated: Apr 13

healing fast from injury using fitness, science papers, fitness scientists, wellbeing, anti ageing, HEALS RICE.

The R.I.C.E. protocol (Rest, Ice, Compression, Elevation) is a familiar fixture in doctors' offices worldwide, but science suggests it's falling short, and might even be doing harm. Surprisingly, this outdated approach, especially icing, remains widely used, despite Dr. Gabe Mirkin, its creator, withdrawing support in 2015. With public health systems under strain, isn't it time we rethink injury recovery? Enter HEALS: a new protocol that prioritizes Health, Exercise, Activities, Lifetime habits, and Sleep. Could this be the change we need? [1]

Media hype often turns initial claims into accepted "truths". Ice as a cure-all was touted back in 1962, and we've been following that flawed path ever since. It probably started when a boy's arm was kept on ice and successfully reattached that year. 48 years, we've been stuck with RICE, despite its obvious flaws, simply because it's become ingrained. Time to question the status quo? When discussing this topic with people, I point out that almost all chemical and biochemical processes in the universe are slowed by cooling, and this includes those in an injury. Lower temperatures decrease the kinetic energy of molecules.

The outdated RICE protocol: A closer look

- Rest: Granted, rest is crucial for severe injuries, but even in this scenario, exercising unaffected areas can aid healing through the cross-training effect. For mild injuries, physical activity is often optimal. Doing nothing leads to muscle loss and associated health risks, plus increased fat ratio.

- Ice: Cooling doesn't accelerate healing. Ice can help reduce swelling in specific cases (e.g., ocular injuries or life threatening swelling), but it can also harm tissue and impede inflammation, a crucial healing process. Avoid ice unless absolutely necessary. [3] [4]

- Compression: There's limited evidence supporting compression; its benefits are largely placebo. Even though some specific injuries might benefit, the word might is not a solid reason to base an entire health service protocol on.

- Elevation: Limited evidence supports elevation; it's a waste of recovery time. [5]

Side note on Inflammation vs Swelling: Inflammation is a vital healing process; don't confuse it with swelling. Ice and NSAIDs (like ibuprofen) can hinder healing by reducing inflammation. Use painkillers judiciously, reserving them for severe cases or hyperactive inflammatory disorders.

HEALS an up-to-date approach to injury healthcare

My general injury protocol H.E.A.L.S. is outlined here. It is meant to be a direct replacement for RICE, it isn't suitable for people with conditions such as lupus, EDS, rheumatoid arthritis, etc. However, some parts of this technique might still be advantageous for these circumstances. I have written this from the perspective of healthcare professionals but it can easily be applied to oneself.

Health Exercise Activities Lifetime Sleep

Health

Evaluate the patient's:

- Current and past physical activity levels including occupations and hobbies. What they have done in the past is a crucial road map to where they are now.

- Overall health.

- Injury cause if known.

Explain to the patient that prevention is key: higher fitness levels reduce injury risk and speeds recovery. However, even fitness fanatics often overlook variety in their routine, leading to recurring injuries (e.g. knee pain in runners or cyclists).

Example scenarios:

- An elite cyclist with knee injury: likely needs workout variation.

- A sedentary 78-year-old with knee injury has weak bones, connective tissue and muscles due to inactivity: needs tailored exercise to address underlying issues.

RICE would hinder recovery in these cases. A personalized modern approach is needed.

Exercise

Encourage patients to exercise:

- To promote healing and prevent recurrence.

- Inform them any delay or non-commitment can worsen injuries or cause further damage.

Advise:

- Focus on training pain-free areas; this is a form of cross training. e.g. if your ankle is injured do push ups on your knees. Or cross-educational training when you train the opposite limb to the injury site.

- Avoid fear; fear of activity resulting in 'rest' can hinder recovery.

- Promote "active stretching" post-aerobic exercise.

- Discourage traditional stretching, which can weaken muscles/connective tissue especially at the site of injury, this is an absolute no no! Common wisdom on stretching is way out of date.

Exercise's healing powers (just a handful!):

1. Increased blood flow, delivering healing agents and removing waste.

2. HGH release (regardless of age), promoting growth and repair.

3. Release of noradrenaline, IGF, BDNF, and testosterone, accelerating healing.

4. Cortisol regulation, optimizing inflammation.

5. Strengthened muscles, reducing recurrence risk.

6. Improved cardiovascular fitness, boosting immunity and repair.

7. Heat shock protein activation.

These benefits make exercise a powerful healing tool.

[6] [7] [8] [9] [10]

Activities

Assess how daily activities might impact the patient's recovery. Encourage patients to:

- Resume regular exercise levels, fearlessly but wisely.

- Avoid repetitive actions on injured areas.

- Explore solutions for physical and mental wellbeing, such as:

- Knee protectors and breaks for physical workers.

- Practical support for single parents (e.g. charity aid).

- Temporary hobby adjustments for mental health.

Empathy and adaptability are key to recovery.

Lifetime

Inform patients that regular, varied exercise for their lifetime is key to preventing injury recurrence. Strengthening the affected area reduces future risk, but whole body exercise reduces future risk for all injuries.

Reality check: bandages, meds, supplements, fancy foods or massages won't fix the underlying issue. Education is the best motivator.

Sleep

Sleep is the only 'rest' with significant scientifically proven therapeutic benefits. Ensure the patient understands the importance of:

- Comfortable bed and pillows.

- Avoids positions that hinder healing.

- Getting as much high quality sleep as possible.

Sleep releases HGH, and many other hormones and epigenetic factors facilitating "active repair" regimens. Inform the patient to sleep like you would treat a workout. [11] [12] [13]

Personal Experience: Fitness Saved My Recovery

Early 2021, I was in a car accident due to another driver's negligence, injuring my chest, pelvis, and spine. As a single parent with kids to care for and COVID rules limiting outside help, I kept moving, training daily, and focusing on pain-free areas while giving extra attention to injured ones. This approach kept me ahead of the game. If I'd followed traditional RICE (Rest, Ice, Compression, Elevation), I'd likely be worse off. My pre-accident fitness probably prevented more severe spinal damage, showing fitness can be life-saving.

Time for a Change

I'm convinced my HEALS Protocol is a better approach than RICE. But science doesn't care about opinions, it cares about evidence. And the evidence says RICE doesn't work, while HEALS is backed by significant research in fitness science over the last 10-15 years. 70 years of outdated practices is enough. It's time for a change.

Let's ditch RICE and revamp healthcare to prioritize exercise physiology and motivational psychology. Every doctor's surgery should involve exercise physiologists/motivators. Let's update medical degrees to reflect the latest findings in exercise science: exercise is the ultimate preventative and therapeutic medicine.

Footnote

I suggest not to use this protocol without consulting a medical professional first. It's currently a proposal, but it'll be the foundation of my plan to replace RICE. I support it wholeheartedly, scientifically, economically, socially, and psychologically. My wish is to improve global wellbeing without personal gain.

I have received no sponsorship or payment for this article. There are no conflicts of interest.

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