Treating Tennis Elbow: Why RICE Is Wrong

Doctors, trainers and other health and exercise professionals are starting to reconsider the "wisdom" of the RICE Protocol (Rest, Ice, etc.) especially ice - Even Dr. Gabe Mirkin, who coined the RICE acronym for sports injury first aid in his 1978 book, has since reversed his position.

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  1. RICE Protocol Treating Tennis Elbow
    RICE Protocol Treating Tennis Elbow
  2. In this comprehensive video, Kelly Starrett (of MobilityWOD on YouTube, and author of 'Becoming a Supple Leopard') interviews Gary Reinl (Author of 'ICED! The Illusionary Treatment Option') on why RICE and ice is the wrong way to treat "muscular" injuries:
  3. Icing Muscles Information | Feat. Kelly Starrett | MobilityWOD
  4. Key Points From The Video About Icing


    – The basic idea of icing is wrong. (Although it does make you feel better temporarily.)

    – Using ice “Minimizes the body's ability to clear waste and bring in nutrients.”

    “Could the body's natural inflammatory response actually be a mistake!?”

    – If it's not a mistake then why are we told to prevent it?

    “There can be inflammation without healing - But there can't be healing without inflammation"
  5. Here's a link to Gary Reinl's book 'ICED! The Illusionary Treatment Option' (on Amazon)
  6. And here, Lauren Beasley, MS, PT, OCS, NKT, reviews the book on 'Breaking Muscle' and seems to agree with the message:
  7. "Ice Delays Recovery," Says Dr. Mirkin


    Dr. Gabe Mirkin, who came up with the acronym RICE for sports injuries in the 1978 book he coauthored, 'The Sports Medicine Book' has reversed his position on rest and ice for most minor to moderate injuries claiming that "Ice delays recovery" - Here's his book on Amazon:
  8. "Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping." - Gabe Mirkin, M.D. - Why Ice Delays Recovery
  9. It seems to be really catching on now. After all, it's long overdue time to reconsider R.I.C.E. and to stop demonizing local, healing-specific inflammation resulting from an injury. Here are several references to articles on sports and fitness-related websites:
  10. Gale Bernhardt, the U.S. Triathlon team coach at the 2004 Athens Olympics, has "switched sides" and is now in the "RICE is wrong" camp, according to her article on Active .com, where she references both Gary Reinl's and Dr. Gabe Mirkin's books. More on my G+
  11. The problem is NOT inflammation, whether we're talking about an Acute injury, like a sprain or a strain - or a chronic injury, like Tennis Elbow. Inflammation is a natural, normal and necessary part of the healing process, and there is no need to "manage" it with ice or, worse, anti-inflammatory drugs (NSAIDs.)
  12. Here's an article in the Toronto Star quoting Gary Reinl, saying that icing "delays healing. It increases swelling, it causes additional damage,” and that "METH is the new RICE." (R.I.C.E. = Rest, Ice, Compression, Elevation - And METH = Movement, Elevation, Traction, Heat) - METH? Well, isn't that catchy!
  13. Here in prominent, online fitness mag, 'Breaking Muscle,' Doug Dupont references Dr. Mirkin and passes on his warning to athletes that although ice can be used to relieve pain in the short term, research suggests that ice also weakens them.
  14. "Cooling may help to decrease pain, but it interferes with the athlete’s strength, speed, endurance and coordination" - Gabe Mirkin, M.D.
  15. In 'Ice Age Melting...' Beth Allen cites Dr. Mirkin and studies published in The Journal of Strength and Conditioning Research and The American Journal of Sports Medicine suggesting that icing delays recovery and that...
  16. "If the treatment reduces inflammation it delays healing. This includes the use of anti-inflammatory pain relievers like ibuprofen." - Am. Jour. Sports Med.
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