Even in a world of “doctors used to say it was good for you, now they say it’s bad,” this one is a shocker: The doctor who coined the acronym RICE (rest, ice, compression, elevation) in 1978 has decided that the (complete) rest and ice are not beneficial to treating injuries.

Dr. Gabe Mirkin, whose RICE treatment plan has been the standard method of dealing with sports injuries for more than 30 years, recently published a blog post that says, in part:

When I wrote my best-selling Sportsmedicine Book in 1978, I coined the term RICE (Rest, Ice, Compression, Elevation) for the treatment of athletic injuries … Ice has been a standard treatment for injuries and sore muscles because it helps to relieve pain caused by injured tissue. Coaches have used my “RICE” guideline for decades, but now it appears that both ice and complete rest may delay healing, instead of helping.

You can read the entirety of Dr. Mirkin’s post here.

This information is significant and could represent a paradigm shift in the treatment of sports injuries in general and golf-related injuries in particular. Simply, reducing inflammation was previously seen as essential to healing. Now Dr. Mirkin and others view inflammation as vital to the healing process. Certainly, there is a gross parallel here with allowing your body to fight off infection vs. antibiotic overkill. As I am not a doctor, however, I’ll leave it at that.

Returning to the matter at hand, as anti-icing advocate Josh Stone of Stone Athletic Management writes: “A shift in paradigmatic treatment is on the horizon. Exercise is heating up and ice is melting down.” By “exercise,” it seems, Stone means load bearing and rehabilitation (alternated with rest) is the advisable course of action. In another post on his website, Stone gives the example of an athlete with a stress fracture to the leg whose been advised to wear a non-weight bearing boot. Stone’s remedy? “An intricate balance between rest and mechanical loading of bone to obtain optimal healing”

In keeping with this idea: Generally, Dr. Mirkin’s advice following injury is as follows:

  • Stop exercising immediately.
  • If possible, elevate the injured part to use gravity to help minimize swelling.
  • If the injury is limited to muscles or other soft tissue, a doctor, trainer or coach may apply a compression bandage.
  • Ice may be applied to reduce pain, however, it’s pointless to apply ice more than 6 hours after injury.
  • If the injury is severe, follow your doctor’s advice on rehabilitation.
  • If the injury is minor, you can usually begin rehabilitation the next day.

The entirety of the new direction of treatment following Dr. Mirkin’s study may only be apparent only to the most progressive doctors, kinesiologists, trainers and exercise physiologists. It is clear, however, that if Mirkin’s current suggestions catch on in the same way as his directions in 1978 did, your rehab and treatment for injury (golf or otherwise) won’t involve anything that lives in the freezer.

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13 COMMENTS

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  1. Icing an injury, especially an acute tendonitis, mild muscle injury or a joint that has been over extended works quite well. I have been observing results for 4 decades and despite the good doctor’s turn around it is still preferable to doing nothing at all. I can even say, observable results from non-iced to iced injuries will take longer to heal and can actually cause chronic conditions. Instead of RICE, maybe another acronym like NIE would be better, NSAIDS, Ice and elevation. Compression usually does not work and if done incorrectly will cause more injury and swelling. ACE wraps are more for mild immobilization than compression anyway. To do away with ice in a sports environment, especially at a higher level of play is tantamount to negligence and assuredly will cause exacerbation of conditions in the long term. This article reminds me of the “Sugar Blues” book that came out in the 70’s that ended up not being worth the paper it was printed on.

    • There are so many things wrong with this post….I don’t even know where to start. So I’ll do it this way…

      1. Compression DOES work; and it’s even more effective when used with exercise

      2. Compression will NOT cause more injury and swelling (seriously, where did you come up with that one?)

      3. ACE wraps don’t immobilize anything (and unless something is fractured, there is really no reason to completely immobilize anything)

      4. The only thing ice is good for is mild analgesia. That’s the only reason I use it on my athletes. After 24 hours…..no more ice.

  2. Stone gives the example of an athlete with a stress fracture to the leg whose been advised to wear a non-weight bearing boot. Stone’s remedy? “An intricate balance between rest and mechanical loading of bone to obtain optimal healing”

    Any physician not recommending nearly complete offloading for a stress fracture is beyond ludacris. Should that stress reaction turn into a frank fracture due to a lack of informing a patient that it is a possibility with “loading of bone”, the physician will find themself in a sticky situation. Wait 4-6 weeks, observe films along with signs and symptoms, then move on with loading.

  3. Ben, first of all please refrain from calling us “trainers” we go to school for 4-6 years to become a certified athletic trainer from an accredited program at an accredited university as opposed to “trainers” who take an online class and teach people how to lift. Secondly, I have been following this article for a while now, and have done a lot of research on my own. Ice is important to help with pain management as well as to keep inflammation at a manageable level. I agree that icing after 24 hours is more or less a placebo/band aid for what is going on. Rehab is the only thing that will help to repair the damage done from an acute injury.
    There is still a lot of research that needs to be done, but ice is not the enemy like Dr. Mirkin and his followers like to portray.

  4. Just take an anti-inflammatory medication instead, as long as you are not allergic. But – ice is definitely good for concentrated, directed use onto the area immediately inflamed by impact.

    But lets not bring up bone fractures into this mix – you’re confusing different issues there, entirely. No amount of ice is going to HEAL bone fractures. It will, however, still alleviate some of the pain in the area surrounding the bone fracture IF there is any inflammation of the muscle or tissues.

    Reducing inflammation is the issue, and ice is OK for those who do not want to ingest any kind anti-inflammatory medication.

    • But that gets to the central question around this entire issue….which is why do we want to stop inflammation? Somewhere along the way we have gotten it into our heads that inflammation is the devil. When in fact, it is necessary for healing. It is our bodies natural reaction to injury and illness…..so it’s obviously supposed to occur (our body is pretty smart). Yet we want to ice and take NSAIDS and intentionally stop our bodies natural healing mechanism. Makes no sense.

  5. While I agree that sharp, sudden injuries may not benefit from ice (ACL, torn muscle, dislocated shoulder) I think it is important to understand that ice treatment can be greatly beneficial to long term injury prevention.

    If someone has tendinitis, but still wants to play the sport that is causing the tendinitis, frequent icing will keep the inflammation at a manageable level allowing the athlete to continue to compete. For example, you’ll see most basketball players icing their knees after a game. Similarly baseball pitchers will ice their entire throwing arm after an outing. Again, this helps control the inflammation and pain to allow the athlete to continue to be healthy and effective throughout a long season.

    • It is becoming more common for pitchers to limit their icing. More influence is coming from Japan, where pitchers don’t ice their arm and have far fewer arm injuries. Correlation is not causation but it has been noticed. Active stretching and heat are becoming en vogue.

      • I would be more inclined to cite genetics versus treatment of chronic arm conditions, especially in pitchers at the professional level. Another thing that contributes is the way young people are taught to play the game versus Japan. A study, maybe by one of those educated trainers trying to get his MS or PhD. would provide more insight into Japan versus the US pitchers.

  6. On most occasions the bullet: Stop exercising immediately is struck over and the round or what ever payed scheduled tennis court or alike is exploited to it’s full extent. Unless one cannot do anything but roll in pain and agony.

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