Monday, December 6, 2010

RICE Revisited

Thanks to Dr. Gabe Mirkin, who gave us the acronym RICE, we have used rest, ice, compression, and elevation for musculoskeletal injuries for years. Then, for a while, we taught IRICE, adding ibuprofen to the acronym. Time hiked on, and we dropped ibuprofen, after learning the negative effects on healing from high doses of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Now we have a small but suggestive study that could lead to dropping the second I.

The fact: we don't know when inflammation is a healthy response of the body and when it's not. We often try to suppress it, in brain injury being one example, in some heart attack patients being another.

This recent study was done on mice by well-respected researchers. The short version is this: 1) Ice slows the entry of macrophages into injured muscle. 2) Macrophages release IGF-1 which promotes healing. 3) Markedly lowered levels of IGF-1 are associated with delayed healing.

RICE will continue to be the standard of care, but watch the evolving literature on this question. Ice may be another do-do bird of medicine, like ibuprofen in high doses, a mask for pain that gets you back into action sooner, but which is mistakenly interpreted as healing.

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