It’s a regular refrain following a bump or a bruise – ice and rest it. For years this has been the official NHS advice for soft tissue injuries such as sprains, strains or pulled muscles.
The full protocol – known by the acronym RICE – stands for rest, ice, compression and elevation. However, growing evidence suggests this approach may be doing more harm than good.
Experts say that using ice, rest and even anti-inflammatory tablets to treat a minor injury may, in fact, prolong the pain and the time it takes for muscles to heal.
Instead, many doctors are now advised to tell their patients to follow a new protocol called PEACE and LOVE – but the problem is, many say they can’t remember what they stand for.
Doncaster-based GP Dr Dean Eggitt said: ‘One of the benefits of RICE is that people can actually remember it and do it. The new guidance makes sense and probably does better encompass what we in the NHS do to treat sprains and strains – but the acronyms may be too complicated.’
Soft tissue injuries include damage to the muscles, ligaments and tendons, and tend to take between four to six weeks to heal.
The new guidance makes sense and probably does better encompass what we in the NHS do to treat sprains and strains, says Dr Dean Eggitt
They can be caused by a sudden trauma – such as a fall, twist or blow – or through overuse of a muscle group, which can occur from poor posture or improper technique when exercising.
For the past few decades, the RICE method has been the primary treatment.
This was first proposed in 1978 by Dr Gabe Mirkin, an American sports medicine physician. Icing and resting a sprain were seen as the most effective way to reduce swelling and speed up recovery.
But the newest protocol, PEACE and LOVE, was developed in response to research suggesting that RICE can actually prolong healing.
Studies have shown that resting an injury while compressing it with ice is not just ineffective at speeding up recovery but can actually further damage tissue.
Cooling down an injury helps to reduce pain and lowers the swelling that occurs as increased blood flow and fluid gathers around the stretched or torn muscle.
But Hassaan Awan, a musculoskeletal physiotherapist at Bodylogics Health and Fitness Clinic in London, says this inflammation is a natural part of the healing process and is needed for the damaged joint to repair properly.
He explains: ‘Blood flow to the affected area helps to hasten the healing. Applying ice is preventing this from occurring by reducing the size of blood vessels in the area and delaying the growth of new blood vessels. As a result, it can prolong recovery time.’
Research has also found that anti-inflammatory non-steroid medications, such as over-the-counter ibuprofen, have the same negative effect.
PEACE, which is intended to replace RICE as the immediate treatment for muscle injuries, stands for: protection, elevation, avoid anti-inflammatories, compression and education.
LOVE stands for: load, optimism, vascularisation and exercise.
Unlike RICE, the method discourages patients from taking ibuprofen and applying ice, and urges them to avoid unnecessary medical treatments (education).
As patients begin to get over the initial injury, they are told to start reapplying weight to the muscles by using the limb again (load), remain positive and confident about recovery (optimism), use movement to increase blood flow (vascularisation) and restore mobility (exercise).
A systematic review, published in the British Journal of Sports Medicine, analysed 11 studies with more than 1,360 patients who received either RICE or the PEACE and LOVE care methods.
Those who used the PEACE and LOVE guidance recovered quicker and had less pain several months later – though swelling remained the same for both groups.
Research has shown that stretching and exercising a muscle injury helps to improve blood flow to the area, prevents stiffness, breaks down scar tissue and promotes faster healing by allowing the tissue to regenerate properly.
In fact, RICE inventor Dr Mirkin, now 90, has since spoken out against his own theory and now recommends early movement for soft tissue injuries.
Even so, the RICE method is still listed as the recommended treatment for sprains and strains on the NHS website.
