Pilates Self Care Saturday: Rethinking RICE in 2025

A close-up of an ice pack applied to an ankle to reduce pain.

For years in Pilates and Fitness many of us were taught to manage sprains and strains with RICE — Rest, Ice, Compression, Elevation. The idea was simple. Reduce pain and swelling early and you will recover faster. The term RICE was coined in 1978 by Dr Gabe Mirkin in his Sportsmedicine Book and it became standard first aid across sport and fitness.

Here is where it gets interesting. In 2014 Dr Mirkin publicly withdrew his blanket support for RICE. He wrote that both ice and complete rest may delay healing because inflammation is part of the body’s repair process. He was not saying never use ice but encouraging us to be more thoughtful about when and why we use it.

Why the change

Inflammation is the body’s alarm and clean up crew. Cooling an area can narrow blood vessels and potentially blunt that response. The research is mixed. Some trials suggest intermittent cryotherapy can reduce pain after ankle sprain while other analyses find only small or uncertain benefits. Ice can help with short term pain but may not speed tissue repair and could slow it if overused.

Newer guidance you may hear about

POLICE replaces Rest with Optimal Loading. Protect the area then introduce sensible movement as soon as it is safe rather than total rest. This reflects evidence that early guided exercise can improve function in the first week after an ankle sprain.

PEACE and LOVE extends care from the first hours through rehabilitation. It highlights education normalising pain avoiding unnecessary anti inflammatories early and gradually loading tissues while also acknowledging psychosocial factors.

What this means for Pilates teachers

We are not here to diagnose. We are here to think clearly and keep people safe.

1. Protect and assess firstIf in doubt about a possible fracture severe ligament injury loss of sensation or unusual swelling patterns refer to a medical professional.

2. Use ice for pain relief if needed with intentIf a client is very sore immediately after a minor soft tissue injury a brief period of cooling can reduce pain. Keep it short and avoid direct skin contact. The aim is comfort not shutting off inflammation.

3. Prioritise gentle movementOnce serious injury is ruled out and pain allows introduce small supported ranges. Think ankle pumps after a sprain or light footwork on the Reformer.

4. Compress and elevate for swelling controlA well fitted elastic bandage or sleeve and periods of elevation can help manage swelling and discomfort in the first day or two.

5. Educate and set expectationsExplain that some swelling and warmth are normal parts of repair. Recovery is rarely linear and is influenced by sleep nutrition and stress.

The grey area

The takeaway is not that ice is bad or that RICE was nonsense. It is that the story is more nuanced. Early overuse of ice and total rest may not help tissues rebuild. Thoughtful brief cooling for comfort can be fine. Smart compression and elevation can be useful. Early guided movement is often beneficial. And decisions should be individual not automatic.

A note on dates

You may have heard the shift happened in 2013. The widely cited public statement from Dr Mirkin was published in 2014 where he wrote that he no longer recommends routine icing and complete rest.

Bottom line for your Pilates studio

• Safety first. Refer when red flags appear

• If you choose to cool make it brief and for comfort

• Keep people moving within pain free ranges as soon as safe

• Teach patience. Healing takes time and good habits

This blog does not replace medical advice. It gives teachers and clients a framework to think more clearly. RICE had its moment and still contributes pieces of the puzzle. Today we combine the best of RICE with POLICE and PEACE and LOVE and we coach the person in front of us.

References

1. Mirkin, G. (2014). Why Ice Delays Recovery. drmirkin.com

2. van den Bekerom, M. et al. (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): 435–443.

3. Bleakley, C. et al. (2010). “PRICE needs updating, should we call the POLICE?” British Journal of Sports Medicine, 44(4): 252–253.

4. Dubois, B., & Esculier, J-F. (2019). “Soft-tissue injuries simply need PEACE and LOVE.” British Journal of Sports Medicine, 53: 72–73.

5. Bleakley, C., O’Connor, S., & Tully, M. (2015). “The PRICE study: the effectiveness of early supervised exercise after ankle sprain.” British Journal of Sports Medicine, 49(21): 1354–1355.