Should You Still Use the RICE Method? New Thinking from Physical Therapists

Learn why physical therapists have expanded their thinking about using the RICE methods and alternative options to RICE.

little-girl-with-scrapped-knee-sitting-at-doctors-office-being-treated

Should You Still Use the RICE Method? New Thinking from Physical Therapists

Learn why physical therapists have expanded their thinking about using the RICE methods and alternative options to RICE.

little-girl-with-scrapped-knee-sitting-at-doctors-office-being-treated

Should You Still Use the RICE Method? New Thinking from Physical Therapists

Learn why physical therapists have expanded their thinking about using the RICE methods and alternative options to RICE.

little-girl-with-scrapped-knee-sitting-at-doctors-office-being-treated

Should You Still Use the RICE Method? New Thinking from Physical Therapists

Learn why physical therapists have expanded their thinking about using the RICE methods and alternative options to RICE.

little-girl-with-scrapped-knee-sitting-at-doctors-office-being-treated
Table of Contents

Whether you Google how to recover from a strain or sprain or ask your grandma, you're bound to get similar advice: rest, ice, compression, and elevation. Known as the RICE method, this well known self-care model is also commonly used by doctors, coaches, and athletic trainers.

The thinking about this go-to solution, however, has changed over the years. Now, Hinge Health physical therapists, among many other experts, recommend a different approach focusing less on rest and more on movement and rehabilitation.

“We discovered that recovery is not as simple as RICE might make it seem,” says Christine Dang, PT, DPT, a physical therapist at Hinge Health. “Over the years, we’ve learned more about the importance of movement in rehab and healing, and RICE doesn’t take that into account. So we’ve realized it isn’t quite comprehensive enough.” 

The alternative approach? PEACE & LOVE. “I like to think of PEACE & LOVE as an extension — or a more detailed version — of RICE,” says Dr. Dang. Here we’ll take a closer look at the PEACE & LOVE acronym and how it compares to RICE.

Our Hinge Health Experts

Christine Dang, PT, DPT
Physical Therapist
Dr. Dang is a Hinge Health physical therapist and board-certified orthopedic clinical specialist with a special interest in helping mountain athletes.
Jonathan Lee, MD, MBA
Orthopedic Surgeon and Medical Reviewer
Dr. Lee is a board-certified orthopedic surgeon and an Associate Medical Director at Hinge Health.
Dylan Peterson, PT, DPT
Physical Therapist and Clinical Reviewer
Dr. Peterson is a Hinge Health physical therapist who focuses on developing clinical exercise therapy programs and member education.

What Is the RICE Method?

The RICE method first appeared in 1978 in The Sports Medicine Book by Gabe Mirkin, MD, and it quickly became the preferred method of treating minor soft tissue injuries like sprains, strains, and bruises. RICE includes: 

  • Rest: Avoid activity for 48 hours to avoid further damage to the injured area.

  • Ice: Apply cold therapy for 20 minutes every two to three hours for the first few days to reduce pain and inflammation.

  • Compression: Wrap the injured area to reduce swelling.

  • Elevation: Raise the injured area above your heart to reduce swelling, throbbing, and pain.

The downside of RICE is that it doesn’t offer guidance beyond the first few days after an injury, and despite its popularity, there is actually little research to support its use. Optimal recovery takes the acute phase of healing into account while also addressing what’s needed for long-term healing to avoid chronic problems. “PEACE & LOVE takes into account this rehab continuum,” says Dr. Dang. In addition, the new model replaces some of the components of RICE based on the latest research.

The PEACE & LOVE Method Explained

The PEACE & LOVE method is a two-part care model that was introduced in 2019 in the British Journal of Sports Medicine to address the complexity of injury recovery. It’s an alternative approach to the RICE method that focuses on movement after an injury, rather than rest.

The PEACE part of the method should be implemented immediately following an injury and for two or three days afterward. Here’s how it breaks down: 

Protect the injured area by scaling back on activity that causes an unacceptable increase in pain instead of avoiding movement entirely.

Elevate the injured area above your heart to reduce pain, throbbing, and swelling.

Adjust anti-inflammatories, such as ibuprofen, that inhibit the body’s inflammatory response. Some experts call for avoiding over-the-counter pain medications. (This is due to emerging research that shows it may be better to allow inflammation after injury because it’s part of the body’s healing process.)

However, at Hinge Health, we know that these pain medications are helpful — and many doctors and guidelines utilize them. This can be a little confusing. But the gist is that if anti-inflammatory pain meds can help relieve your discomfort such that it’s easier for you to move, sleep, work, and do other daily activities that promote healing, then it’s probably fine to take them in limited amounts as needed. But try to keep in mind that they’re just one part of an overall recovery plan. Drugs like ibuprofen work to stop the inflammatory response in your body, but this inflammation can also be helpful for healing. In fact, research suggests that these medicines may impair tissue healing, especially if they’re used at high doses. If you’re in a lot of pain, talk to your doctor before using them.

Compress the injured area with an elastic bandage or sleeve to reduce swelling.

Educate yourself on the benefits of active recovery methods, such as movement and exercise therapy. (A physical therapist can help you with this.) This also involves listening to your body, which often has the amazing capacity to adapt and heal on its own without the need for expensive scans, tests, and medical interventions.

The LOVE part of the PEACE & LOVE acronym should begin a few days after an injury. It entails: 

Load the injured area by gradually returning to normal activities, using pain as your guide. Know that some pain during or after activity is okay, but your pain should not exceed an acceptable level for you. 

Optimism. This involves believing that you have the capacity to heal and can return to meaningful activities. While this may not seem like a critical component of healing, the brain plays a significant part in rehabilitation. “This is probably the most underrated component of the model, but it's very important,” says Dr. Dang. Research shows that factors such as catastrophization, depression, and fear can significantly delay healing. Believe, instead, in your body’s natural healing process and know you are doing everything you can to support it.

Vascularization means increasing blood flow to the injured area by engaging in cardio exercise you can handle. This might include walking, biking, or swimming. Research shows that this improves function and work status, and reduces the need for pain medication.  

Exercise, or an active approach to recovery, restores mobility and strength. You can use pain as a guide to gradually progress your exercise and increase difficulty.

PEACE & LOVE vs. RICE 

The PEACE part of the PEACE & LOVE method replaces RICE, while LOVE is a new component altogether. RICE focuses on treating an injury in the acute stage (or the first three days after an injury). PEACE & LOVE takes a big-picture approach, focusing on treating the person, not just the injury, which includes rehabilitation after the first few days to prevent chronic problems and psychological barriers down the road.

The most notable difference between these two methods is the shift from rest recommended in RICE to promoting movement in PEACE & LOVE, which is captured in the load, vascularization, and exercise components of the acronym. Even in the acute phase, movement is encouraged by recommending that you protect an injury instead of resting it.

“Prolonged rest can lead to other issues, such as deconditioning, so muscles aren’t able to handle the loads they’re supposed to,” says Dr. Dang. This is why bed rest is no longer the standard protocol after hip or knee replacements. Patients are often helped out of bed and walking within hours of surgery because the longer you avoid movement, the weaker and tighter muscles, tendons, and ligaments become, which impairs function. Early mobility helps with recovery.

“Telling people to protect an injury is just a more accurate recommendation than telling them to rest it. For example, if you injured your ankle playing soccer, you don't want to go back to playing soccer right away. You can rest from soccer specifically, but it’s important to find other ways to move your ankle.”

While RICE doesn’t specifically recommend complete bed rest for days or weeks, the lack of any reference to movement makes it easy to avoid activity longer than necessary, especially if you’re afraid of reinjuring yourself. 

Christine Dang, PT, DPT
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The other component of RICE that is missing from PEACE & LOVE is ice. This is because research shows that ice can inhibit inflammation, which is necessary for healing. Inflammation is often thought of as something to avoid or minimize. That is true of chronic and systemic inflammation associated with conditions such as heart disease, diabetes, and arthritis. But inflammation is a critical step in the healing process after an injury like a sprain or pulled muscle. It triggers the body’s immune response that prepares the area for subsequent repair and remodeling. This is why the PEACE & LOVE method also suggests avoiding anti-inflammatory medications. 

What About Education? 

The last element in PEACE is education, which is an example of how the new model focuses on the whole person and not just the injured body part. This component aims to encourage people to allow their bodies to heal naturally without feeling obligated to spend money on scans, tests, medical interventions, or other treatments. For minor injuries, they are usually unnecessary.

Moving Beyond RICE

The transition away from RICE has been happening for more than two decades as we learn more about optimal recovery. Before PEACE & LOVE, some experts recommended PRICE, adding protection to the RICE method. Then POLICE was suggested, replacing rest with optimal loading and recognizing the benefits of movement.

As more studies are done, it’s likely that PEACE & LOVE will evolve, too. Until then, PEACE & LOVE can offer guidance the next time you sprain your ankle, twist your knee, pull your hamstring, or experience another type of minor soft tissue injury.

When to See a Doctor

Although PEACE & LOVE can be used to address many injuries, you should seek medical care if you experience any of the following: 

  • Your pain is severe enough that you can’t put weight on the injured joint, or you can’t move it at all. 

  • The area feels numb. 

  • You took a big fall. 

  • There is redness or red streaks around the injury. 

  • The injured area looks disfigured. 

  • You can’t manage the swelling, or it’s not going down after a few days.

PT Tip: Don’t Let Fear Take Over

Being cautious after an injury is understandable, but fear can hinder recovery. “Sometimes people are so scared of re-injuring themselves that they end up doing too little. And that ends up being more detrimental,” says Dr. Dang. It’s natural to be a little fearful after an injury. But instead of focusing on your fears, listen to your body. “If you move, and you don’t feel any pain during or after — or you feel that it’s an acceptable level of discomfort — then you’ve likely found your ‘movement sweet spot’ and can feel confident in continuing to move,” says Dr. Dang. “Listening to your body is the best bet.” 

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.  

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

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References

  1. Scialoia, D. &. Swartzendruber, A. J. The R.I.C.E Protocol is a MYTH: A Review and Recommendations. The Sport Journal, 24. 

  2. van den Bekerom, M.P., Struijs, P.A., Blankevoort, L., Welling, L., van Dijk, C.N., & Kerkhoffs G.M. (2012). What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? Journal of Athletic Training, 47(4), 435-43. doi:10.4085/1062-6050-47.4.14

  3. Dubois, B. & Esculier, J. F. (2019). Soft tissue injuries simply need PEACE & LOVE. British Journal of Sports Medicine, 54, 72-73.

  4. Dubois, B., & Esculier, J.-F. (2019). Soft-tissue Injuries Simply Need PEACE and LOVE. British Journal of Sports Medicine, 54(2). doi:10.1136/bjsports-2019-101253

  5. Lin, I., Wiles, L., Waller, R., Goucke, R., Nagree, Y., Gibberd, M., Straker, L., Maher, C. G., & O’Sullivan, P. P. B. (2019). What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. British Journal of Sports Medicine, 54(2), bjsports-2018-099878. doi:10.1136/bjsports-2018-099878

  6. Briet, J. P., Houwert, Roderick. M., Hageman, M. G. J. S., Hietbrink, F., Ring, D. C., & Verleisdonk, E. J. J. M. (2016). Factors associated with pain intensity and physical limitations after lateral ankle sprains. Injury, 47(11), 2565–2569. doi:10.1016/j.injury.2016.09.016

  7. Bleakley, C. M., O’Connor, S. R., Tully, M. A., Rocke, L. G., MacAuley, D. C., Bradbury, I., Keegan, S., & McDonough, S. M. (2010). Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ, 340, c1964. doi:10.1136/bmj.c1964

  8. Tissue Healing (2021, December). National Strength and Conditioning Association. https://www.nsca.com/education/articles/kinetic-select/tissue-healing/

Table of Contents
What Is the RICE Method?The PEACE & LOVE Method ExplainedPEACE & LOVE vs. RICE What About Education? Moving Beyond RICEWhen to See a DoctorPT Tip: Don’t Let Fear Take OverHow Hinge Health Can Help YouReferences