Tim: Ice reduces blood flow, and hence swelling and pain.  But it's entirely logical that, by the same mechanism, it also retards healing.  Tight bandages also limit swelling and restrict blood flow.  Only empirical findings can tell us whether they restrict flow, and hence retard healing,  as much as ice does.  I haven't the clinical experience to know the answer, but the weight of experience indicated by this discussion certainly makes me think that, for an athlete whose principal concern is to get back to fitness as quickly as possible, I'd in future use compression without ice.  For thenon-athlete, whose primary interest is avoidance of pain, I'd continue with the full RICE regime till more is known.  Neil

Hi Tim

Always good to challenge current practice.  This question was asked as part of the International Liaison Committee on Resuscitation (ILCOR) (http://www.ilcor.org/home/) 2010 review (http://circ.ahajournals.org/site/C2010/FA-603C.pdf).  They specifically asked 2 questions:  “Does cooling of musculoskeletal injury improve outcome?” and the other is “If so, what is the optimal method of cooling?”.  The results were yes however the evidence was weak.  It is worth reading the worksheet.  The other questions then also flowed into if it is useful how long and what is the best method. Ice in water was found to be the best method and should not exceed 20mins, although some nerve injuries (with spontaneous recovery) was found in the 15-20 min range.  

I do note that this is in the initial acute phase and may not be useful at any other time.  The main thing is the need for more and well constructed research.  A great opportunity if you are working with athletes at a University.

So in the wash up I would continue with RICE for the acute injury, and continue to work on preventing it from occurring in the first place. 

You may also be interested in the follow questions:

• "Does heat applied to a musculoskeletal injury improve outcome? And if so, what is the optimal method of applying heat?" (http://circ.ahajournals.org/site/C2010/FA-604B.pdf)
• "Does applying a compressive bandage to an injured extremity joint compared to not applying a compression bandage improve outcome?" (http://circ.ahajournals.org/site/C2010/FA-601A.pdf). 

There is also a 2015 process underway and that might add more evidence to the mix.

I hope this helps regards

Richard

Hi Tim,

RICE depends on what type of injuries we are looking into. If it is a mere sprain or strain, a simple RICE helps (http://www.webmd.com/fitness-exercise/understanding?page=2#2) . If you are talking about injuries concerning fractures, RICE merely assist but not diminish the pain, heal or recover.

It is also dependable on the individual's body heat. If he / she is cold-blooded - cold compress would not heal nor recover but exacerbate the pain instead and vice versa for those with warm blooded - towels aside.

As Richard indicated,

My suggestion is think about the end then work out your RICE and rehabilitation plan. If surgery is a must - please do not delay further, age may be on your side, but not your body parts.

Regards

- Mariam

Thanks a lot for all the answers. I really appreciate all your help. Unfortunately I am not yet working with athletes, so I am not able to do a research, although I would really love to do it in the future, as this theme is really interesting.

I will be lecturing to Slovenian sailing coaches on a conference and among things to cover is also recovery, so I was looking for the latest data and opinions.

Honestly Tim,

It does not take sports or athletes to sprain, strain or fracture one's bones.

A simple fall would put a person in shambles. I am one of those who tore my wrist ligament completely and needed to be reconstructed for about 5 hours after 4 operations excluding bilateral shoulder operation within a space of a year.

If you are talking about recovery, try to understand CRPS too - i.e. Complex Regional Pain Syndrome as it is always associated with operations that involve nerve complications that could turn the wrist or the affected body part yellow, red and blue and mostly hypersensitivity to all kind of touches - no matter how mild.

Concerning RICE- my advice remains for sprain and strain. But for recovery - RICE is the gold standard for as long as the injuries are minor - once fracture(s) set(s) in - operation has always been the best option.

Good luck with your conference and data collation - if you need more personal information or opinion, I am available for your study except that I am no athlete, sailing or otherwise.

Best regards -

Mariam Ahmad

No doubt that RICE is a proper method in prehospital treatment for injuries

Please visit the link

https://www.researchgate.net/publication/281192522_Soft_Tissue_Injury?ev=prf_pub