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    • 01 OCT 15
    • 0

    Is R.I.C.E still right?

    Think RICE is the way forward?  Think again.  ARITA is…

    The health, fitness and medical industries are complicated, fraught with confusion and conflicting approaches to everyday problems, amplified by the modern day access to information on the web. It appears however, that some of the clearest logic is found when such ‘problems’ are viewed through the eyes of a child and appropriately questioned.

    The acronym RICE (Rest, Ice, Compression, Elevation) has been the go-to method for acute injury management by clinicians and the layman alike since its inception in 1978 by Dr Gabe Mirkin3. Almost 40 years on and Dr Mirkin was quoted in the foreword of Reinls’(2014) book:

    “Forty years ago I coined the term RICE as the treatment for acute sports injuries. Subsequent research shows that rest and ice can actually delay recovery. Mild movement helps tissue to heal faster and the application of cold supresses the immune responses that start and hasten recovery. Icing does help suppress pain, but athletes are usually far more interested in returning as quickly as possible to the playing field. So today, RICE is not the preferred treatment for an acute athletic injury”

    The acronym RICE has actually been replaced by the concept of ARITA where Active Recovery Is The Answer.

    Tissue healing is a 3-stage process with each phase unable to happen without the preceding phase, of this, there is no controversy4. The three phases include, in order:

    1. Inflammatory – cellular and vascular response to injury
    2. Repair – replacing necrotic {dead} tissue with new matrix {cells}
    3. Remodelling – reorganising of new matrix

    It’s during this acute inflammatory period that blood vessels become more permeable (microvascular changes) in the area allowing more blood to access the injured tissue. This extra fluid brings with it all the machinery (including leukocytes to initiate the immune response, oxygen and nutrients) necessary for this highly metabolic process to enable repair (phase 2) to take place.

    Clinically this manifests as five cardinal signs that include rubor (redness), calor (warmth), tumor (swelling), dolor (pain) and functio laesa (loss of function)5. These are the characteristic signs most can relate to, and the best advice up until now has been to try and prevent these (swelling most commonly).

    So the question remains, once inflammation is in full swing, do you just leave nature take its course?

     “One of the most important concepts in orthopaedics in this century is the understanding that loading accelerates healing of bone, fibrous tissue and muscle”4

    ARITA When to Apply

    ARITA When to Apply

    “Anything impeding the acute-inflammatory response in acute injury management is CONTRAINDICATED”

    Based on the information covered, some reasonable recommendations in acute injury are to “use your brain, don’t cause pain”. Activate as much local musculature to the injury as possible, as often as possible. If this is too painful, then move some muscles distal (further from the centre of the body) to the injury. This way lymphatic return is still being actively facilitated.

    It must be made clear however that there is a significant difference in the physiology of acute inflammation and chronic inflammatory diseases such as Crohns disease or Rheumatoid Arthritis. These are modern day western ailments where the immune system has turned on itself and often times does require medical intervention. Another important caveat with the ‘use your brain don’t cause pain’ approach is that of chronic pain (greater than 3 months)25.


    Clinical Knowledge Summaries (A physicians portal to current best practise as provided by the NICE guidelines) actually define acute as less than 6 weeks and anything longer as chronic23. There is a lot of weight pointing to the fact that tissue damage does not correlate with pain levels in these people and will be the feature of a future post21, 22. A thorough assessment here at Prohab would distinguish whether pain free movement would guide your individual approach.

    It is important to note for those concerned about a chronic inflammatory process that ARITA and RICE may be applicable in conjunction with medical investigation. In this instance, all the reasons we want to avoid ice in acute trauma are the exact reasons we might want to apply ice to counteract an EXCESSIVE inflammatory reaction. It is also reasonable to continue active recovery simultaneously as relief with exercise put you in this category in the first place!

    Here at Prohab we are on board the ‘movement movement’ as oppose to ice at any stage of an injury where we apply a unique approach to reintegrate primal movement patterns on a path away from pain and toward optimal function. If you are suffering plateaus in exercise performance, lingering pain or dysfunction and would like to push through those training plateaus, enhance movement patterns and bullet proof yourself of pain then our approach could be a game changer for you.

    You will always have some pain free movement available to you, your job and ours is to help you find that movement and utilize it progressively back to full health. An integral piece of this approach is to be in touch with where painful movements actually are; so strong painkilling medication can be misleading. These should be avoided where possible or as soon as possible.

    The facts on ice are compelling, old news to some, new to many, either way soon to be routine for all. Ice makes an interesting reference against the Primum non nocere (Latin translation of the hypocratic Oath), first do no harm; evidence suggests it might.

    Whether ARITA will catch on or not, who knows, but there is a movement and common sense tells one to get ahead of the curve and come in from the cold.


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    12. Bleakley, C. M., Costello, J. T. Glasgow, P. D. (2012). Should Athletes Return to Sport After Applying Ice? A Systematic Reviewof the Effect of Local Cooling on Functional performance, Sports Medicine, 42, P.69-87.
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    19. Pountos, I., Georgouli, T., Calori, G. M. and Giannoudis, P. V. (2012). Do Nonsteroidal Anti-inflammatory Drugs Affect Bone Healing? A Critical Analysis, Scientific World Journal [online]available from: (accessed 16th August 2015).
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    21. Moseley, F. (2012). Targeting Cortical representations in the Treatment of Chronic Pain: a Review, Neurorehabilitation, Neural Repair, 26 (6), P.646-52.
    22. Jensen, M. C., Brant-Zawadski, M. N., Obuchowski, N., Modic, M. T., Malkasian, D. and Ross, J. S. (1994). Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain, New England Journal of Medicine, 331, P.69-73
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    25. 25.  Hargrove, T. (2014). A guide to Better Movement: The Science and practice of Moving with more Skill and  Less Pain, Seattle, USA.
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