R.I.C.E. Therapy….the OLD school way of healing!

REST ICE COMPRESSION and ELEVATION is a mainstream approach to injury and/or inflammation yet have you ever really stopped asked WHY this approach may be effective? In our experience society is so quick in adopting new ideas we never really stop and ask the questions “How” and “Why” something may work or not work.  If we did we might realize the R.I.C.E approach to inflammation really does not make sense.

Lets begin by understanding what occurs in the body at time of injury.

In the event of an injury white blood cells (WBC) are often the first on site at the  surface of a wound. White blood cells ingest and destroy foreign matter and bacteria. If an object or organism is too large to ingest, the WBC’s will adhere to the object and seal it off. As WBC’s make there way in, other inflammatory mediators are released to assist in wound closing and scar formation. At the same time damaged cells in the area release histamine that increase capillary blood flow to the damaged area. This is often presented as heat, redness and swelling.  This heat is part of our adaptive mechanism, which makes the environment unfavorable to microbes, promotes healing, raises mobility of WBC’s and increases the metabolic rate of nearby cells. Of course it is a bit more complex and much more happens, but this is the simplicity of it….and as you can see, WBC’s and phagocytosis are an important part of the healing process.

Any situation inhibiting optimal cellular respiration and/or where excessive inflammation is present decreases the function of the immune system and increases susceptibility to infection. Any suppression of the immune system at times of injury decreases the ability of the body to heal itself.

“Either cold or hypothyroidism tends to suppress or delay phagocytic activity of white blood cells.” Ray Peat PhD….as you just learned, heat plays a huge role in their activity. Thus cold or ice would actually have a negative impact on WBC activity and phagocytosis, making ICE therapy counter productive to our physiological healing process.

body diagram

Inflammation is a complex process, which occurs at a cellular level. In keeping it simple; our cells use glucose and oxygen in glycolysis, along with Vitamin A, T3, Mg, Copper and light, to produce energy = ATP and CO2. When we are lacking specific nutrients, there are factors preventing the production of thyroid hormone.  “Tissue respiration refers to the absorption of oxygen from the blood by cells, or, more exactly, to the exchange of gases between cells and their environment.” ~Ray Peat PhD.

Three key aspects of carbon dioxide (CO2) production are oxygen (O2), T3 (thyroid hormone) and sucrose. CO2 optimizes cell respiration, functions similar to an antioxidant and is one of the most protective chemicals in the human body. In an efficient state, our cells produce CO2 through optimal cellular respiration; the mitochondrial use of O2 to produce CO2 and energy (ATP).

Pure carbon cannot be transported in the body so CO2 is one form it takes that is water-soluble. Levels of CO2 indicate to the body when it needs more O2.

Carbon Dioxide (CO2):

  • Is the end product of efficient oxidative metabolism
  • Facilitates energy production
  • Regulates pH levels in the blood.
  • Dilates smooth muscles surrounding the bronchial airways, bladder, bowel, arteries, etc. Low levels of CO2 will cause increased BP and vasoconstriction of blood vessels.
  • Transports O2 to the tissues through the bloodstream via the hemoglobin molecule. The Bohr effect shows that if CO2 levels are low oxygen molecules will not dissociate from the hemoglobin molecules to the optimal level.
  • Regulates intra-cellular calcium, important for building bone and supports regeneration
  • Supportive to the immune system, liver and thyroid
  • Promotes the efficient use of glucose

Optimizing cell respiration means increasing the use of O2 at the cell level to provide energy and to increase overall functional capacity, thus reducing inflammation.  Low levels of O2 will interrupt cellular respiration, shifting your cells energy production away from CO2 and towards producing lactic acid = inflammation. Without oxygen, pyruvic acid (metabolized from glucose) can be converted into lactic acid.

“You can’t use O2 efficiently without CO2. CO2 is produced in the cell and releases O2 into the tissues which has many affects on relaxing the blood vessels, preventing edema, eliminating ammonia and increasing oxidative metabolism.” ~Ray Peat PhD.
Lactic acid is a huge metabolic burden to your metabolism. It is not only inflammatory and moves your cells away from energy production, but it also causes the liver to use up stored glycogen. The body depends on this stored energy for times of stress. Stress of any kind will increase the cells need for  glucose, signaling adrenaline.  Adrenaline begins the mobilization free fatty acids from the tissues placing an additional burden on the cells and energy  production. Lactic acid is antagonistic to CO2, is a factor in degeneration, immunosuppression, promotes cellular hypoxia, free radicals, increases intra-cellular calcium and free fatty acids, as well as wastes glucose damaging the mitochondria.

To summarize:

  • Heat increases mobility and activity of WBC’s – cold does the exact opposite
  • Vitamin A, T3, copper, red light and sucrose all upregulate CO2 production, which facilitates optimal use of O2 at the cell level, thus being anti-inflammatory
  • Lactic acid is antagonistic to CO2
  • Lactic acid facilitates inflammation
  • Cold constricts, decreases WBC activity, wastes glucose and creates hypoxia at the cell level, thus increasing inflammation
  • Any suppression of thyroid hormone in the body lowers body temperature and leads to a hypo-metabolic and/or hypothyroid state. Low body temperature perpetuates inflammation. With this said, the theory of applying ice to an injury needs to be reconsidered!
  • “When ice is applied to a body part for a prolonged period nearby lymphatic vessels begin to dramatically increase their permeability (lymphatic vessels are ‘dead-end’ tubes which ordinarily help carry excess tissue fluids back into the cardiovascular system). As lymphatic permeability is enhanced, large amounts of fluid begin to pour from the lymphatics ‘in the wrong direction’ (into the injured area), increasing the amount of local swelling and pressure and potentially contributing to greater pain.” The use of Cryotherapy in Sports Injuries,’ Sports Medicine, Vol. 3. pp. 398-414, 1986 (Thanks Doug Parra)

The R.I.C.E. principle


Defining the type of rest appropriate for any one person at a time of injury is going to be person specific. In our point of view rest is not recommended however, we do find proper modifications in daily activity regimens along with the appropriate manual therapy are highly supportive in assisting the healing process.

Walking, breathing squats or safe types of movements to pump the lymphatic system are key in facilitating the healing process.

The lymphatic system pools around T12-L1 at the cysterna chyli, moves up the anterior thoracic spine via the thoracic duct and moves to the left subclavian vein and internal jugular veins under the clavicle. This system is the most common drainage of the trunk and of the body’s lymphatics.

Using circulatory techniques, pumping techniques, anti-inflammatory techniques and fluid regulation techniques are all essential and an integral part of assisting increased circulation.

An example of this would be the work of Guy Voyer D.O. Guy Voyer uses circulatory techniques of Scarpa’s Triangle and many other smaller and larger veins to assist in circulation. This can be manually applied by a practitioner, but also be given as a home program.

Warming up (jogging in place, light walking) is essential to executing any drainage. Proper execution includes:
3 sets for 20 reps – dynamic movement through full range of motion
10 seconds- localized static isolation
20 seconds – osteo-articular drainage. This step must be performed above the heart.

Here is one example of how to create circulation within the deep femoral vein using the adductor longus:

Patient (Pt) position
patient position-Side lying
-Top leg bent with foot either on the ground in front or on top of the bottom legs thigh= resistance
-Bottom leg is straight, foot internally rotated (toes point up) = working limb

-Adduct the straight leg against resistance through its full range of motion

-Hold in the abducted position with the resistance provided Osteo-Articular Drainage
-Place bolster under hips, have Pt hold their thigh
-Shake thigh back and forth either actively or passively

Other manual therapy examples are:

  • Pumping of the cysterna chyli
  • CV4
  • Balancing of the 3 diaphragms
  • Venous Sinuses
  • Freeing up lesions within the pelvic basin, thoracic spine, shoulder and clavicle to increase lymphatic flow
  • Freeing up the diaphragm of the foot, especially the cuboid-navicular, which plays a role in the lymphatic pumping mechanism
  • Freeing up the inter-osseous membranes of the upper and lower extremities


The energy to WBC is a very important part of the healing process. As you can see above, heat is part of our adaptive process to allow WBC to do their phagocytic job. “The energy available to the WBC’s and the condition of the various tissue cells, governs the process of phagocytosis, healing and tissue remodeling” Ray Peat PhD. Thyroid hormone and body temperature  are important factors in governing the activity of the white blood cells. As well, the rate of movement of the white blood cells through the tissue is strongly dependent upon temperature. So we can deduct that optimal cellular respiration through not only food, but applying heat would make much more sense.

The Chinese for thousands of years have viewed “cold” as a pathogen. Cold constricts, holds things in, causes tightness, impairs circulation, causes contraction and stagnation. It can either be from an external source or internal source. A more effective approach could than ice would include acupuncture and herbs that are warming, the use of moxibustion treatments (heat producing) and topical ointments (Tiger Baum, Po Sum On, White Flower Balm) to reduce stagnation and increase circulation.

C = Compression

We are not for or against this part of RICE, but once again the use of compression will depend on the individual and their injury. As mentioned, there are many manual therapy techniques that are of great benefit to increase circulation aiding in the healing process. We think compression at times might be needed, but most of the time it is not something we recommend. When there is a sound manual therapy program in place, using compression techniques such as socks and wraps is not needed.


Appropriate elevation techniques should be assessed and integrated into the manual therapy program or the home program of the client. Elevation can be of assistance when used to allow for drainage of the affected area, however elevation alone without the proper plan will not create drainage, as there is stagnation in the affected area.

Other tools to help reduce inflammation

Epsom salt baths: Magnesium sulfate shares a very special relationship with progesterone which set the stage for healing by inhibiting the loss of magnesium when the body is in an injured or hypo-metabolic state. Under situations of hyper adrenaline/cortisol magnesium is easily lost from the cell while calcium is being pulled into the cell. Calcium is highly excitatory effecting the entire CNS through the up regulation of all inflammatory markers. As you know, lactic acid increases intra0-cellular calcium and CO2 decreases it. Magnesium stabilizes nerve function by down regulating calcium and creating relaxation in the muscle tissue. Other sources of magnesium include: mineral broth (made from kale and/or spinach), bone broth, tropical fruits and coffee. Click here to learn more about the benefits of magnesium and specific instructions on how to use epsom salt baths!

Aspirin itself is highly misunderstood. Although we have been aware of its ability to inhibit inflammatory prostaglandins for decades now,  we have been left in the dark about the healing benefits of aspirin.

  • Is anti-estrogenic and aromatase inhibitor
  • Antioxidant that protects against lipid peroxidation from unsaturated fats (above ground veggies, fish oils, vegetable and seed oils)
  • Stimulates mitochondrial respiration which helps to produce efficient energy in the body.
  • Inhibits abnormal cell division and promotes normal cell division
  • Reduces clotting
  • Prevents in the new development of blood vessels
  • Helps to prevent the toxicity of dopamine, glutamine and other toxic free radicals
  • To learn more about aspirin click here …..and here!

Proper nutrition: According to Ray Peat PhD, histamine that is released during inflammation can stimulate the production of cortisol and free fatty acids, raising blood sugar and shifting cell metabolism over time away from glucose oxidation and towards lactic acid production. This is one of the many reasons why nutrition based on human physiology is key in the healing process.Under injury and/or stress the body is very specifically designed to maintain blood glucose and down regulate adrenaline. Eating balanced meals frequently throughout the day is essential to maintaining blood glucose levels which further up regulates mitochondrial respiration and energy production in the cell promoting a deeper level of healing. Avoiding high inflammatory foods such as unsaturated fats from fatty fish or fish oils and vegetable and seed oils, also including fish oils and fatty fish. “Mitochondria from animals which are fed a diet lacking the “essential” unsaturated fatty acids are more resistant to oxidation.” Ray Peat PhD.

Through Osteopathic Manual Therapy and Craniosacral Therapy, EastWest Healing and Performance observes the wholeness of the body and assists the body through the process of auto-regulation. There are so many factors to consider when working to help someone reach optimal physical and overall vitality. It is not as simple as RICE. Now maybe the next time someone recommends RICE (hopefully this will not happen) you will have the inclination to ask more questions. Doing so gives you back the power of your own health and healing by providing you choices.

This is not another “DIE-t” but a guide (FREE download) in helping you define exactly what you need to support yourself nutritionally, increase energy and live the life you desire!

Joshua and Jeanne Rubin


1. The use of Cryotherapy in Sports Injuries,’ Sports Medicine, Vol. 3. pp. 398-414, 1986

2. Peat, Ray PhD. Townsend Newsletter: Brain Aging. 1992

3. Peat, Ray PhD. Townsend Newsletter: Chronic Fatigue. 1994

4. Canadien College of Osteopathy (2010), The Sacrum

5. Canadien College of Osteopathy (2004), The Iliac

6. Canadien College of Osteopathy (2008), The Lymphatics

7. Canadien College of Osteopathy (2007), The Lower Limb 1

8. Voyer, Guy D.O. Sutherland Academy: Circulatory and Diaphragm Techniques. 2006

Subscribe for updates from East West Healing
+ Restoration Thyroid: 5 Proven Ways to Heal Your Adrenals and Boost Your Metabolism with Food Audio Series

Share Your Thoughts