We’ve all heard the R.I.C.E. acronym when it comes to acute injuries. Rest, ice, compress, elevate. For years this has been the accepted practice for acute injuries. However, more recent evidence suggest that this analogy may not be the quickest way to get back in the game. The new acronym of R.A.C.E may be a better choice when addressing early injury (Recover Actively, Compress, Elevate).
The body is an amazing healer of itself, and the inflammation that occurs following injury is the body’s way of initiating this healing process. Traditional icing will constrict blood vessels and limit blood supply. This does indeed address the swelling associated with injury, however it also limits the arrival of immune cells and interferes with the core parts of healing. Without the initial inflammation, injuries will not heal as quickly as they potentially could. Several recent studies suggest that icing the affected area interferes with the first part of the healing process, decreases blood flow, and delays and reduces the amount of healing chemicals. The advantage of icing, and what likely accounts for its continued use, is that it decreases pain. However, this can come at the expense of overall recovery speed.
Furthermore, studies looking at excessive rest with an injury also have determined that lack of movement and skeletal muscle contractions will delay the body’s ability to recover. The lymphatic system which is the body’s natural drainage system, naturally and slowly removes all the waste products and excess fluid buildup caused by the inflammatory process. The lymphatic system is heavily dependent upon muscle contraction, so early movement versus the traditional “Rest” theory can be a key component in a faster recovery.
Where swelling does initiate and assist in recovery, excessive swelling can contribute to muscle shut down. In these cases, gentle compression of the injured area using an ace wrap or one of the many compression socks/ sleeves that are on the market can assist. Elevating the injured area can also be very helpful in encouraging the fluid to move back toward the lymphatics where the body is able to process the swelling. As an example, with an ankle or knee sprain we often have patients lie on their backs with legs elevated against a wall. From there, simply pumping the ankles and squeezing the leg muscles will encourage movement of the fluid back to the central system where the body can process it.
Keep in mind that the physiology of pain associated with injury is very powerful. Even though a particular recovery method might not be clinically proven, a person’s strongly held belief in it can enhance the placebo effect which actually does help in recovery. However, after reading this perhaps keep the R.A.C.E. acronym in mind the next time you suffer a sprain or strain and don’t hesitate to contact us for guidance so you can get back on track with the activities you enjoy!
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Jared Buzzell is the manager of the physical therapy center for Spectrum Orthopedics in Saco, ME. He is an Ironman athlete himself and specializes in evaluation and treatment of the endurance athlete.