RICE: The End of an Era?


The RICE method has become commonplace in classroom teachings and the textbooks of sports medicine and first aid practitioners. The origins of this acronym are beyond me, but currently most health professionals and the general public carry out the RICE principles when faced with a sudden injury – regardless of what the injury may be.

For those of you not familiar with the RICE acronym, it stands for Rest, Ice, Compression and Elevation. While the goal of using the RICE method is to reduce pain and inflammation in an effort improve recovery time, there is no research to support its use over any other type of injury care.

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Ankle sprains are one of the more common injuries that will have people carrying out the RICE method. Perhaps it’s because ankle sprains are arguably one of the easiest injuries to both compress and elevate (ever try elevating your low back?!). A 2012 article in the Journal of Athletic Training reviewed all available randomized controlled trials on using the RICE method for acute ankle sprains. Their review found that there was “insufficient evidence to determine the relative effectiveness of this therapy in adults” and that “treatment decisions must be made on an individual basis after weighing the relative risks and benefits of each option”.

I’ve come to believe that the growing utilization of the RICE method is most likely due to the accessibility of the equipment needed to hit all four points of treatment. If you have access to ice and a tensor band then you can RICE the heck out of most injuries. If you’ve been following my posts, you know that I’m big on active care. The RICE method is largely passive. Kicking your wrapped ankle up on the couch with an ice pack and watching all 5 seasons of Game of Thrones shouldn’t be the extent of the “care” you’re receiving. It requires very little thought, direction and energy. (Check out: Rest ≠ Recovery). The Scotch enthusiast in me advocates a different acronym for injury care.

MALT: Movement, Acupuncture, Laser Therapy and Taping.

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To my knowledge, no research to date has looked at all four treatment types in combination for treatment of a particular type of injury. There is however an abundance of research on each individual treatment type for numerous acute and chronic injuries. In my experience, there is a synergistic effect (1+1=3) when combining these therapies and patients are able to return to their day-to-day activities such as work and sport much faster.

The broadest category in the MALT acronym is undoubtedly “Movement”. Movement can take the form of mobilizations and manipulations of the soft tissues and joints, graded exercises to fit the type and severity of the injury, etc. I have a few posts already covering the importance of movement (Movement is Medicine, The Three Components to Optimal Injury Repair). In my practice, the use of Functional Range Release and Functional Range Conditioning techniques have been one of the most valuable tools to help my patients from a movement perspective.

Lots can be said about both acupuncture and laser therapy. For the sake of brevity I will discuss these two topics in greater detail sometime in the near future. At Mountain Health and Performance our chiropractors have had great success with class IV laser therapy for a wide variety of acute and chronic injuries (ankle sprains, muscle strains, tendonitis/bursitis, neck and back pain etc.).

Taping is probably the part of the MALT method which I use most conservatively. There is a time and a place for various treatment interventions. Athletic taping can provide structural support to an injury, while Kinesiotaping can provide additional proprioceptive input to the injured tissues. Sometimes one or both of the taping styles can be used depending on the type and severity of the injury.

Overall, the MALT method has been something we’ve been using with great success at Mountain Health and Performance. Ironically, I’ve been using it on my own recently sprained ankle with significant improvements thus far. Don’t settle for the RICE method if you’ve got an acute or nagging injury. Book your appointment at Mountain Health and Performance today if you have a new injury that you think needs “time” to heal or if you are dealing with stubborn chronic pain that has not responded well to other treatment options.

Out with the old, in with the new!

Written by: Dr. Matthew Wentzell