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Dr. Mirkin Amends RICE to Exclude Ice

Ice, as it turns out, might not help some wounds you heal

If you have worked in a gym or at a pool or anywhere that requires first-aid certifications, you have probably heard of RICE. It’s an acronym that stands for Rest Ice Compression Elevation as defined by Dr. Mirkin, the author of the term in 1978 with in Sportsmedicine Book.

According to Mirkin, ice has been a standard treatment for injuries and sore muscles because it helps relieve pain. Anyone that has used ice can probably attest to the truth of that statement.

Not only is pain reduced but ice reduces swelling dramatically. The reason for this is that ice cools and thereby constricts the blood vessels that are filling the damaged area, causing it to swell. In a 2015 article, Dr. Mirkin said,  “A summary of 22 scientific articles found almost no evidence that ice and compression hastened healing over the use of compression alone, although ice plus exercise may marginally help to heal ankle sprains (The American Journal of Sports Medicine, January, 2004;32(1):251-261).” You can find his article here.

When you damage tissue via trauma or overuse, you heal by using your immunity, the same mechanism that your body uses to kill germs. This process is called inflammation. Inflammation presents as pain and swelling in the body, but your body requires it to heal. Mirkin said, “When muscles and other tissues are damaged, your immunity sends the same inflammatory cells to the damaged tissue to promote healing. Inflammatory cells rush to injured tissue to start the healing process (Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999).”

By virtue of this fact, it might be easy to see how ice keeps healing cells from entering injured tissue. To that effect, anything that reduces inflammation will also delay healing.


Icing and Climbing

So what do we mean by inflammation reducing substances? Dr. Mirkin says, “Anything that reduces your immune response will also delay muscle healing. Thus, healing is delayed by:

  • cortisone-type drugs,
  • almost all pain-relieving medicines, such as non-steroidal anti-inflammatory drugs like ibuprofen (Pharmaceuticals, 2010;3(5)),
  • immune suppressants that are often used to treat arthritis, cancer or psoriasis,
  • applying cold packs or ice, and
  • anything else that blocks the immune response to injury. “

This is important to consider as many of these substances are frequently used in climbing. It is not uncommon to hear someone asking for the “Vitamin I” in relation to ibuprofen or to hear them aggressively icing to get over a finger injury. Cortisone injections have their place in regard to certain injuries/conditions (especially in relation to reduced cartilage and Dupuytren’s Contracture) but even still, they are not solutions, but buffers.

What is most important about all of this is to stop freezing your hands. Finger injuries are massively debilitating for climbers and they take a long time to heal from. Instead of icing, strive to complete mobility exercises and increase blood flow through heating them. That said, ice does have its place. If you are in exceptional pain directly after an injury, ice it. Dr. Mirkin says, “You could apply the ice for up to 10-minutes, remove it for 20-minutes, and repeat the 10-minute application once or twice. There is no reason to apply ice more than six hours after you have injured yourself.”

In that same vein, mobility exercises like pen-rolling, rice bucket, and a general warm-up on your rest days are also good for increasing blood flow. If you are injured and unsure of the severity or cause, consult a medical professional.

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PEACE & LOVE ❤️💛💙 Should we all be moving on from the old (but easy to remember) acronym many of us have been using when it comes to injury? The RICE protocol has been around since the 70s and whilst it had some common sense foundation, it’s subsequently been superseded by further methods like PRICE (The P being “Protect”). One of the latest suggestions – see Blaise Dubois above – is moving into a more rounded approach of taking the whole athlete picture into account. Not just the physical!! Many thanks to @tim_pigott (we use him a lot for Physio work – it’s great he’s an elite athlete himself! 😁) for putting together this info graphic for us. Always amazing to see others sharing our passion for expanding the knowledge and understanding of the sports community. #climbingtraining #moonboard #climbing_is_my_passion #tradclimbing #sportclimbing #bouldering #gritstone #ukclimbing #indoorclimbing #latticetraining #latticer #climbing_lovers #climbing_pictures_of_instagram #climbing_is_my_passion #klettern #escalade #klatre

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