I'm sure you will have all heard and used R.I.C.E. when faced with a sprain or soft tissue damage. Me too, until I learnt otherwise and now I have a supply of Arnica cream on hand instead.
How did R.I.C.E. come about in the first place?
It all stared in America in 1962 when a twelve year old boy jumped onto a freight train, resulting in his arm being completely severed from his body. A team of doctors attempted to save his arm and successfully performed the first limb reattachment in history. The operation’s success quickly became a global phenomenon and the application of ice to preserve the severed tissue became the main focus of the story. Like a game of Chinese Whispers, the facts began to change and eventually the notion that any injury should be treated with the application of ice became the general consensus, regardless of its severity or how it occurred. (1)
Let's break it down.
Rest, Ice, Compress, Elevate. These actions are to alleviate pain and swelling but do not address the injury itself. In fact some of these actions actually hinder the healing process in quite a major way.
When soft tissue damage is sustained the body's inflammatory response is triggered, dilating blood vessels and increasing blood flow to the affected area. This is essential so that immune cells (such as macrophages) can reach the injury site, to rebuild and to clear debris. This creates swelling as the debris collects before it is removed, and can be uncomfortable. If ice is applied, the blood vessels shrink and blood flow is reduced. This limits the amount of immune cells and oxygen that can be carried to the area. It also stops the immune cells that do reach the site from performing their job well, such as inhibiting macrophages to release the hormone IGF-1 which helps aid the healing process.
There is another large issue with the R.I.C.E. acronym, the Rest part.
The debris from an injury is removed by the lymphatic system, which relies on muscle contraction to work. Think of it like a one-way drainage system being operated by a pump. The vessels of the lymphatic system contain smooth muscle tissue which contracts involuntarily to propel the lymph (the fluid containing the debris) along. The lymphatic system also requires voluntary muscle contraction to operate. Resting the injury site will slow down the rate at which the debris is removed and the swelling is reduced, and therefore slow down the recovery. Studies have also shown that immobilisation of an injury can actually increase the longevity of pain, due to a slow healing time. (2)
So how can we help soft tissue damage repair?
We need to promote blood flow to the area. This is where Arnica cream comes in handy. It is a vasodilator, meaning that it promotes blood flood by increasing the diameter of blood vessels. Massage also increases blood flow in and out of the injury site carrying all the good stuff in and the bad stuff out. I like to massage the cream on and around the injury (it's great for when children bump their head). Or if you don't have Arnica to hand, massage without cream would be just fine. Avoid any creams containing anti-inflammatories like Ibuprofen though. We want the inflammatory response to be triggered.
It's also important to keep the injury site mobile. This doesn't mean carry on dancing but just gentle movements to increase blood flow, load the tissues gently to promote rebuilding, and help the lymphatic system remove debris.
Good nutrition and hydration will also help speed up the recovery process. I will cover this in another post so keep an eye out for that!
References and further reading
Disclaimer: This blog is for educational purposes only, not medical advice. An injury should be assessed before treating.