This is the first part of a post from guest blogger Craig Donovan. Craig studied physiotherapy at Curtin University and is currently working in a rural hospital setting. He has a strong interest in research, particularly in the areas of pain and neurology. After recently completing a project looking into the association between the brain and pain, he is a strong believer in the importance of the brain in pain control.
The acronym of RICE is one of the most commonly used acronyms when it comes to treating acute injuries. The term was first used back in 1978 by Dr Gabe Mirkin, MD and has been widely used from medical staff to the average Joe who rolls their ankle. But now the very same doctor who brought this acronym to our attention has wrote a post explaining that two of the key components of RICE (rest and ice) may actually delay healing.
This is a topic close to my heart long before I studied physiotherapy, I have always wondered and questioned the benefit of using the RICE principal. The human body works in marvellous ways to keep us fit and healthy. Inflammation is a natural process vital to healing injured tissue. So why are we trying to decrease the inflammation to the area?
Firstly we need to understand the basics of healing, which is a very complex process involving three stages. The first is the inflammatory phase (which I will discuss), then the proliferative phase and lastly the remodelling phase. There is a large migration of cells to the area which aim to clear dead tissue and deposit the necessary growth factors which are used later in the process to repair the damaged tissue. A study has shown the importance of the presence of growth factor in healing of mice.
Therefore it is important that both the initial inflammation response occurs to bring the necessary cells of inflammation to the tissue to allow for healing. Adequate drainage is also necessary to assist in drainage of the dead cells from the injured tissue which occurs through both the lymphatic system and the venous system.
This begs the question as to why is ice used?
Firstly ice causes vasoconstriction which closes downs capillaries and therefore reduces the ability of the cells to reach their target tissue. It also reduces the size of the veins and therefore the amount of blood being drained from the affected area. Studies have demonstrated that ice reduces the permeability of the lymphatic system resulting in an increased ability for cells to move out of the lymphatic system into the surrounding tissue .
Now it is likely that some people will argue that ice is used to reduce the risk of secondary cell death that occurs to surrounding healthy tissue. It does this by lowering the metabolic rate and oxygen demands of the surrounding cells. However as other studies have shown, ice also inhibits the ability to reduce drainage from the area and therefore this inability to drain swelling from the area can also lead to secondary cell death due to the healthy tissue not receiving adequate blood flow.
Non steroidal anti-inflammatory drugs (NSAID’s) are commonly used for acute injuries but how effective are they?
They work by reducing the effect of prostaglandins, which are cells responsible for producing inflammation. As the evidence has shown that reducing inflammation results in reduced a decreased immune response and therefore causes delayed healing. Therefore anything that claims to decrease the inflammatory response is likely to in fact delay healing time.
So what is the best way to manage acute injuries and prevent delayed healing?
Stay tuned for the next post.
Please share your thoughts or questions below.
By Craig Donovan
• Cottrell, and O’Connor, P. Effect of Non-Steroidal Anti-Inflammatory Drugs on Bone Healing. Pharmaceuticals, Vol 3, No 5, 2010.
• Haiyan Lu, Danping Huang, Noah Saederup, Israel F. Charo, Richard M. Ransohoff and Lan Zhou. Macrophages recruited via CCR2 produce insulin-like growth factor-1 to repair acute skeletal muscle injury. The FASEB Journal. Vol. 25 no. 1 January 2011. 358-369.
• Forsyth, A. L., Zourikian, N., Valentino, L. A. and Rivard, G. E. (2012), The effect of cooling on coagulation and haemostasis: Should “Ice” be part of treatment of acute haemarthrosis in haemophilia?. Haemophilia, 18: 843–850. doi: 10.1111/j.1365-2516.2012.02918.x