Forget that ice pack

In 1978 an influential doctor, Gabe Mirkin, published a bestselling book: The Sports Medicine Book. In addition to sports medicine, Mirkin was an expert in many other fields. He was also a competitive marathoner and a charismatic guy. In his book, he promoted a method on how to treat sprains which he called RICE: rest, ice, compression, elevation. RICE became the go-to treatment for decades to follow. It turns out that his RICE idea was based more on instinct than evidence.

Beginning in 1989 researchers began performing experiments to test the theory. The tests continued through 2013. Their conclusion: there is no evidence that ice helps with pain, swelling, or speed of recovery. Ditto for rest, compression, and elevation.

The studies showed that cold packs actually worsen outcomes. That’s because inflammation—which increases blood flow—is the key to healing: increased blood flow increases clotting factors, brings immune cells to the rescue, and helps to manufacture more collagen. Thus, anything that decreases blood flow only lengthens the time to healing. In fact, heat is better than ice.

In 2013, Dr. Mirkin recanted his earlier advice: “There are no data to show that ice does anything more than block pain. And there are data that show it delays healing. RICE is just something that stuck—and it’s wrong.” As to rest, Mirkin said, “Nobody believes in rest anymore. You can get a hip replacement and you’re on the bike 12 hours after surgery.”

Yet doctors still give us ice packs. It takes years for old ideas to die. But once the no-ice idea catches on, sales of frozen peas will probably drop.

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