Is RICE Best After Injury? Study Suggests Rest Prolongs Recovery Interview with:

Monika Bayer PhD. Institute of Sports Medicine Copenhagen Bispebjerg Hospital Denmark

Dr. Bayer

Monika Bayer PhD.
Institute of Sports Medicine Copenhagen
Bispebjerg Hospital
Denmark What is the background for this study? What are the main findings?

Response: Acute muscle strain injuries display a major clinical problem with a high incidence rate for both professional and amateur athletes and are associated with substantial risk for recurrence. Common clinical practice advices to follow the RICE (Rest – Ice – Compression – Elevation) principle after strain injuries but it has not been investigated whether patients really benefit from a period of rest or whether an early of loading following the injury would improve recovery.

In this study, amateur athletes were divided into two groups: one group started rehabilitation two days after the trauma, the other group waited for one week and began rehabilitation after nine days. All athletes had a clear structural defect of the muscle-connective tissue unit following explosive movements. We found that protraction of rehabilitation onset caused a three-week delay in pain-free recovery. In all athletes included, only one suffered from a re-injury. What should clinicians and patients take away from your report?

Response: Our study shows that loading is essential for a shortened period of pain after an acute muscle strain injury and that rest prolongs recovery. Early after trauma, the injured tissue should be put under careful load in regular intervals. We suggest a continuous and gradual increase in load to prevent aggravation of the injury, and we further recommend continuing with rehabilitation/ specific training even though an athlete is symptom free. Tissue healing most likely exceeds the phase during which patients have symptoms. An athlete should first return to sports when pain-free to avoid adverse long-term effects. What recommendations do you have for future research as a result of this study?

Response: The high risk of re-injuries following strain injuries suggests that the interface between the muscle and connective tissue suffers long-term or even permanent damage. The precise sequences during tissue healing after a strain injury, in particular the repair of the muscle-connective tissue interface, is unknown. It seems crucial to elucidate the sequence of the regeneration process of the muscle-connective tissue connection and investigate further long-term changes associated with muscle strain injuries. Is there anything else you would like to add?

Response: Another aspect is pain, loading and the connective tissue. It appears as if the regeneration of connective tissue is the main player following muscle strain injuries and one could speculate that pain is linked to modifications of the connective tissue. There are several studies showing that loading has hypoalgesic effects on connective tissue, but the underlying mechanisms have not been extensively investigated.

Disclosures: This study was funded by the Bispebjerg Hospital, Greater Region of Copenhagen Research Foundation, Danish Rheumatism Association, Lundbeck Foundation, Danish Council for Independent Research, Novo-Nordisk Foundation and Anti Doping Denmark. Thank you for your contribution to the community.


Early versus Delayed Rehabilitation after Acute Muscle Injury

N Engl J Med 2017; 377:1300-1301September 28, 2017DOI: 10.1056/NEJMc1708134

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.


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Last Updated on October 4, 2017 by Marie Benz MD FAAD