R.I.C.E. or M.E.T.H.?

By Lisa McInnes

I’ll never forget when one of my lecturers asked, “Isn’t Meth the new Ice?” After a few chuckles he was met with confused faces and a collective “huh?” I didn’t investigate this any further until my interest was recently triggered by seeing a journal article titled “The effects of cold water immersion and active recovery on inflammation and cell stress responses in human skeletal muscle after resistance exercise.” Working with a football club, I was interested and curious as to the practice of icing an injury and the use of ice baths post game for recovery and also as a nurse with occasionally post-operatively applying ice packs to orthopaedic surgical sites (surgeon dependent of course).

The study investigated the current belief of cold water immersion (ice baths) after exercise and its effect on skeletal muscle. It’s believed this reduced inflammation, compared with active recovery such as resistance exercise. Interestingly, the study found there was no human data available to support the theory of cold water immersion after exercise and that it is no more effective than active recovery for minimising the inflammatory and stress responses in muscle after resistance exercise.

So why has it been drummed into us as consumers and practitioners to use ice, even on acute injuries? Most of us are aware of the acronym R.I.C.E. (or R.I.C.E.R.)  which stands for Rest, Ice, Compression, Elevation, (Rehab/Referral).

Have you heard of M.E.T.H.? This stands for Movement, Elevation, Traction and Heat and brings us back to the old debate….heat or ice? Does this newer acronym not contradict our current practice and beliefs? Of course it does! So what do we do? I believe the most important question to ask at this point is WHY? Why are we applying heat or ice? What are we actually trying to achieve? What is our purpose? Are we using ice as an attempt to numb the injured area or to reduce the swelling as a direct effect from inflammation?

What were we trying to achieve using ice? For years, with first aid and an acute injury we rested the area so as not to worsen or aggravate the injury further, applied ice to reduce inflammation thereby reducing swelling as this was considered counterproductive. Compression for support and to reduce swelling, elevation to reduce swelling, then rehab to strengthen the injured area. But why do we want to reduce inflammation? The body has an astounding capacity for healing and multiple buffer systems to maintain homeostasis, eg pH levels, water retention and of course conducive environments for healing. Will we really effect it?

So why use M.E.T.H? How does this work in the setting of an acute injury? Mobilising an injury or the tissues around it, with traction, will provide support whilst assisting lymphatic drainage as the muscles compress the lymph nodes moving lymphatic fluid back to the subclavian veins thereby reducing swelling. Elevation helps this process and heat will also increase blood flow enhancing the healing environment.

There are three phases of healing – inflammation, proliferation and maturation or remodelling (Physiopaedia.com). Without inflammation, the next two phases of healing are affected and impeded, the body cannot skip a stage. If this is so, then why are we trying to prevent it?

Current practice is slowly changing and is starting to gain momentum. As Elle’s blog ‘Ankle Sprains: Is Rest Really Best?’ explains, the benefits and importance of early implementation of therapeutic exercise in the successful rehabilitation of ankle sprains. Rest is not really best! Ice is following this path…

Gary Reinl, author of Iced: The Illusionary Treatment Option discusses there can be inflammation without healing but there cannot be healing without inflammation.

Have a look at the video below featuring Kelly Starrett and Gary Reinl about the change in culture for the elite sportsperson in America and their move away from the use of ice with improved outcomes for those athletes.

Very importantly, Gary mentions we need to keep in mind our purpose for using ice. If we want to numb the area to assist with pain relief then by all means use ice, but if our purpose is to reduce inflammation then we need to reassess our practices.



So what should we do from here? There are many blog posts and opinions on moving away from ice and using heat but what we really need are further clinical studies and research evidence so as practitioners we are using best practice to ensure our clients are receiving the best treatment to help them reach their goals and potential. Remember, if you have any questions contact your practitioner for further advice.


Further reading:

Reinl, Gary Iced: The illusionary treatment option. 2nd edn


Peake J, Roberts L, Figueiredo V, Egner I, Krog S, Aas S, Suzuki K, Markworth J, Coombes J, Cameron-Smith D, Raastad T, The effects of cold water immersion and active recovery on inflammation and cell stress responses in human skeletal muscle after resistance exercise. The Journal of Physiology, 2013 Nov, Vol 595 (3), p695-711