Updated: Oct 9, 2018
If you have been unfortunate enough to experience an acute injury, then there is no doubt you are familiar with the traditional RICE approach to injury management. Rest, Ice, Compression, Elevation. And when there is pain, we are conditioned to ‘kill’ the pain with pain killers or anti inflammatory drugs. What you may not realise, is that some of these treatment therapies are outdated, and can actually slow down your healing process.
Because the RICE approach has been around so long, we assume it is correct, and many find it confronting to go against the norm. This is especially true when TV shows, professional sports and common (outdated) knowledge continually expose us to the same old approaches. It’s a bit like watching the Heimlich maneuver on TV when someone chokes. This outdated approach hasn’t actually been taught in first aid for at least 15 years (it's been shown to create harm), but is what most people think works to stop someone choking. It’s hard to break through with new knowledge and approaches, when we are continually exposed to, and familiar with the old.
This blog is about some very common sense, and progressive approaches to injury recovery, which go against the norm of what we have learned. When asking someone to go against what they know, there is usually an element of fear in trying a new approach. This is especially true when it comes to pain, which naturally shifts us closer to fear based thinking. There is so much fear surrounding acute injury that we often forget the most important part of injury rehabilitation - listening to our body and reconnecting the injured part to the system.
When we get injured, our body launches the inflammation process to the injured area. Inflammation is your bodies innate response to injury or illness, and it’s process involves various types of signaling molecules, immune cells, and blood clotting proteins. Inflammation is helpful to stabilise the area to prevent further injury, and increase the proprioception throughout the injured area. Swollen, inflamed tissue helps us restrict painful movements and prevent additional damage. Inflammation is your body sending nutrients to the injured area, and helping the immune system respond to the threat of injury.
“There can be inflammation without healing but there can not be healing without inflammation” - Gary Rein
Although this is your bodies natural response to healing itself, many of us second guess this process, and think of inflammation as bad. The problem isn't inflammation itself, the problem is when inflammation is delayed or lingers. Lingering inflammation (think puffy, sore skin) that takes longer than it should to clear is often the result of poor circulation. Inadequate blood flow to the area will mean that the nutrients and immune processes needed to remodel tissue suffer restricted access. Poor lymphatic flow from the area means that waste pools at the site of injury. The lymphatic system is a one-way system with no pump, it relies on movement to push waste through.
Move don’t rest
Before you recoil in horror thinking about moving an injured part, allow common sense to prevail. We are talking about subtle movement. Why? Well without movement there is simply no way to pump the lymphatic waste. When the injured site is swollen with inflammation, it needs more movement to help pump it through. Above we discussed how swelling upregulates your proprioception (feedback) to the injured area. With this heightened sensitivity, your body will tell you quickly if the movement is too much, so it's easy to move intelligently within your bodies threshold.
Failing to move with injury will have negative ramifications throughout the body. Circulation will be decreased, fascial tissue will stiffen up, hormone balance, blood sugar, metabolism, digestion and waste removal processes will all be negatively impacted. The longer movement is avoided, the more scar tissue and fascial thickening will occur, leading to long term compensations, inefficient movement, and chronic pain.
Failing to move intelligently results in a lack of ‘space’ in the body. Injuries often result from a lack of space in a joint. Either this space is lost from trauma, or over time the soft tissue at the joint has been glued up, which caused the lack of ‘give’ or efficiency which ultimately led to the injury. Either way a good recovery strategy will aim to create spacious joints by facilitating healthy, hydrated fascia that can mitigate force through it’s whole web like system.
We recommend the following types of movement for healing:
TINY movements on or around the injured area. If you twist your ankle, can you bend and extend your knee, even just wiggle your toes. Any type of subtle movement that doesn’t increase pain will help speed up the healing process.
Movement in areas away from the site of injury. Even if you can’t move your injured part, moving other parts of your body will help keep circulation and lymphatics pumping. For example an injured knee will do well with movement at the hip and foot.
Apply external movement near injured areas. This might be gentle massage, frictional massage, skin tractioning, or best option – Vibration. Vibration tools will help rapidly move the area, without having to actually move the injured part. Vibration tools accelerate the removal of inflammation.
Avoid treatments that decrease precious feedback
Pain is a symptom that needs attention. Symptoms protect us from further injury. When you dull the pain with ice or anti-inflammatory drugs, you risk further injury. By moving around on an injured part that can’t tell you it’s hurting, you delay healing. When you numb an area, it can no longer communicate effectively with the rest of the body (and brain!)
1. Use Heat to treat - not Ice
Unless you need to numb the area with ice because pain is excruciating, or because you are competing in a sporting event and need to finish your game/race with injury (not a smart idea) then ice isn't a good option.
Ice restricts the blood vessels and slows down circulation. Slow circulation delays the flow of the lymphatic fluid, which creates more congestion. Ice will numb the area limiting the bodies communication network, making us less able to tell what movements hurt. Icing can take away pain, but moving on a numbed part will often cause further damage.
Heat therapy is considerably more comfortable and effective than ice. Heat therapy will increase blood flow to the injured area and help get nutrients in, and take the garbage out. Hot baths, Infrared saunas, and heat packs are all great options. Read more about why icing isn't a good option here.
2. Compression for pressure difference, not rigidity
Compression is the one part of the RICE approach that can still be useful. Compression that is designed to make the body rigid and stop movement isn't ideal, but compression strategies designed to enhance circulation are brilliant for helping move inflammation through.
Rigidity is the enemy of our body. For this reason avoid protective braces, tight bandages etc that seek to immobilise the area. When you decrease movement at the injured site for too long, you increase movement elsewhere, restrict circulation and function, and can start to promote dysfunction. The sooner you can integrate subtle movement of the injured part back into the whole system, the better.
Compression techniques that are applied, and removed can help generate an increase in circulation by helping to create a pressure difference. Think of what happens when you put a kink in a hose and stop the flow of fluid. When you release that kink, the pressure increases and the water is pushed through more rapidly. This is what happens when you apply, and remove pressure techniques to injured areas.
3. Don’t elevate, move!
Why would you make it even harder to increase circulation to the injured area by encouraging blood to pump UP hill! In addition elevation does nothing for the lymphatic system, which relies on the pump of your muscles to help push lymphatic fluids through the body.
4. Avoid the drugs!
If the injury pain is unbearable then anti inflammatory drugs will have a role to play for your emotional health in dealing with the pain. However these drugs are best avoided for minor injuries because they actually stop the signal of the inflammatory response. As we have discussed, this process is crucial for healing. Non steroidal anti inflammatory drugs (NSAIDS) will address the smoke signals your body is giving you, but they won't help the underlying fire, and potentially may be increasing it.
Using traditional NSAID's is a double edged sword because they may help reduce pain, but they damage the gut, reduce nutrient absorption, delay recovery, and damage tendons.
There are many effective herbal anti inflammatory agents that are much safer. Turmeric is probably the most well known these days but, Ginger, Green Tea, Oregano, Boswellia, Rosemary and Holy Basil are a few other great supplements to take to help speed up healing.
Essential oils are also fantastic at creating natural pain reduction through a cooling or heating of the skin, and by promoting circulation. Peppermint, eucalyptus, wintergreen and blue tansy are very effective for pain.
5. Watch what you eat
Your nutrition when injured is crucial to your success. Most people ignore the connection between how your fuel your body, and how you move and recover. Food is powerful information, and what you put in your mouth at any time (even more important when you are injured) will either build you up, or break you down.
Avoid pro-inflammatory foods like sugar, refined vegetable oils, alcohol, preservatives etc.
Eat more whole foods that don’t come with ingredients lists. Aim to eat a nutrient dense, anti-inflammatory diet rich in colourful, fibrous vegetables, pasture raised and fed animal sources, and healthy fats. When injured it's especially important to eat more collagen rich foods like bone broth (add chicken feet for extra collagen and rapid healing,) meat off the bone, collagen powder etc for rapid healing.
Next time you get injured, avoid the RICE approach, which aims to block your bodies natural healing processes, and instead help your body to perform the powerful natural healing process it’s was made for!