The human body hasn’t really changed in thousands of years but our understanding of it certainly has.

It’s about 2,500 years since Hippocrates, regarded as the father of medicine, was treating his patients in Ancient Greece. Millennia of medical insights and foolish notions, trial and error and, more recently, robust research and evidence-based practice has taught us a great deal about the human body. We now have a deep understanding of its anatomy and physiology, including its amazing immune system that heals many injuries and diseases.

And we’re still learning.

That means new research can and does overturn established practice. We no longer use heroin-laced aspirin to help children recover from a sore throat. Arsenic is thankfully no longer a remedy for headaches. And icing is no longer the recommended treatment for soft tissue injuries.

Wait! What did I just say?

We’re so used to using ice that it seems almost heretical to hear someone say it doesn’t really work. Yet that’s what new research shows. 

Why RICE is wrong

Advice to RICE (rest, ice, compress and elevate) soft tissue injuries dates back to the 1970s. The RICE method was thought to help by reducing inflammation and congestion after an injury. Plus ice feels nice and soothing, right? Just what you need if you’re hot, sweaty and hurt.

Now we know that all inflammation is not bad. Acute inflammation in response to an injury plays an essential role in healing and injury repair. You get symptoms like pain, redness and swelling because your body is sending a mini paramedic team of white blood cells and other fluids to the area as part of the soft tissue healing process. Icing the area disrupts this process by constricting your blood vessels. It’s like putting a roadblock in front of an ambulance.

A 2014 review of the evidence found that, ‘There is limited evidence from randomized clinical trials (RCTs) supporting the use of cold therapy following acute musculoskeletal injury and delayed-onset muscle soreness.’

As I said above, we’re always learning new things in health care. And the bloke who first promoted icing injuries now says, ‘Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.’ Good on him for respecting new evidence rather than being welded to his theory.

So, what should you do if you’ve rolled your ankle or twisted your knee? If there are signs of a fracture, go straight to hospital. If there’s no concern about fractures, then give the injured area a bit of PEACE and LOVE.

PEACE and LOVE

Yes, it’s a hippy thing, but PEACE and LOVE is now recommended by your physio too. Except in our case, it stands for:

• Protection – avoid painful activities and movements initially
• Elevation – lift the injured limb higher than your heart when you can
• Avoid anti-inflammatories – avoid aspirin and ice as they reduce tissue healing
• Compression – bandage or tape to reduce swelling 
• Education – learn to trust your body’s healing response
• Loading – gradually return to normal weight-bearing activities if your body feels OK
• Optimism – maintain a positive mindset
• Vascularisation – pain-free cardiovascular exercise increases blood flow
• Exercise – an active approach to recovery restores mobility & strength

So, what about heat?

The same 2014 review of the evidence into icing injuries also examined the evidence for heat and found, ‘There is limited overall evidence to support the use of topical heat in general; however, RCTs have shown that heat-wrap therapy provides short-term reductions in pain and disability in patients with acute low back pain and provides significantly greater pain relief of delayed onset muscle soreness than does cold therapy.’

The take-away message? If your back hurts or your muscles are sore a day or so after exercise, then heat won’t hurt and may help a bit.