It was a gorgeous summer day in the foothills of Northern California. Heart pumping, lungs on fire, running full speed on a mountain trail ... until an unseen tree root initiated three somersaults and the beginning of four years of ankle pain. The ankle healed, but here's what those four years taught me: managing an acute injury and rehabilitating persistent pain are two very different things.

Questioning the RICE method

Aching back? Pulled muscle? Strained shoulder? For decades, the advice has been practically automatic: RICE—Rest, Ice, Compression, Elevation. Introduced in 1978 by sports medicine physician Dr. Gabe Mirkin, RICE became the standard response to soft-tissue injuries.

But here's the kicker. In 2014, Mirkin himself publicly reconsidered the recommendations he helped popularize. Emerging evidence suggested that prolonged rest and routine icing might actually interfere with healing rather than accelerate it.¹

As our understanding of tissue recovery evolved, so have the acronyms. In 2012, POLICE introduced Protection and Optimal Loading, replacing prolonged rest with appropriate movement. By 2019, researchers proposed something more memorable: PEACE & LOVE.² PEACE addresses the immediate injury response: Protection, Elevation, Avoidance of anti-inflammatory modalities, Compression, and Education. LOVE guides subsequent recovery through Load, Optimism, Vascularization, and Exercise. Unlike RICE, this proposed framework also emphasizes restoring function.

A look at the research

Here’s where things get interesting. We've spent decades attempting to suppress inflammation following injury, yet inflammation is an essential part of tissue repair. Immune cells help remove damaged tissue and initiate the processes necessary for regeneration. So, could suppressing that response interfere with healing?

Research suggests it's possible. A 2023 animal study found that icing following muscle injury reduced the accumulation of inflammatory macrophages and the development of regenerating muscle fibers.³ Another study demonstrated that cooling delayed the removal of damaged muscle tissue and disrupted the cellular activity involved in muscle regeneration.⁴

A 2025 study published in The Journal of Physiology compared cold, neutral, and hot-water immersion following experimentally induced muscle damage. Interestingly, cold-water immersion did not improve muscle regeneration, while hot-water immersion demonstrated favorable effects on markers of muscle repair.⁵ Although this doesn't establish that icing delays healing, it challenges the long-held assumption that cold is necessarily the best choice for recovery. A 2024 critical review published in the British Journal of Sports Medicine found no evidence from human studies that cryotherapy improves tissue regeneration or prevents secondary injury.⁶

So, is ice harmful?

Not necessarily. It can temporarily reduce pain, which certainly has value. But reducing pain isn't the same as repairing tissue, and there's little evidence that routinely icing accelerates recovery.

Was my ankle acutely inflamed for four years? Not necessarily. But the altered movement patterns and compensatory biomechanics that developed following the injury snowballed into a larger problem. Also, persistent pain doesn't automatically indicate persistent inflammation. Changes in mobility, strength, neuromuscular control, load tolerance, and pain sensitivity may contribute to symptoms long after the initial injury.

How this applies to the dental clinician

Now consider the dental clinician who finishes every workday with an aching neck, shoulder, or back. Out comes the ice pack. The pain subsides, at least temporarily, and the next morning it's back to the operatory for another eight hours of prolonged static positioning, repetitive instrumentation, and sustained muscular demands.

Sound familiar?

When those demands repeatedly exceed our capacity to tolerate them, discomfort can become a recurring problem. Yet we continue reaching for the ice pack as though we're treating an acute injury. What are we accomplishing if the pain returns every day?

Ice may quiet the symptoms, but it doesn't restore strength, improve mobility, correct compensatory movement patterns, or increase our capacity to tolerate the physical demands of dentistry. At some point, we must stop asking how to quiet the pain and start asking why it keeps coming back.

That's where rehabilitation through progressive loading, appropriate exercise, mobility work, neuromuscular retraining, and ergonomic modifications to the workplace practices contributing to symptoms can help restore function.

So, is RICE completely retired? Not entirely. Protection, compression, elevation, and even brief icing may still have a place in managing an acute injury. But when discomfort becomes persistent, repeatedly treating the symptoms without addressing the underlying contributors is no longer the answer.

RICE isn't completely cooked, but it's certainly no longer the whole recipe.

Related: Wellness Corner: 5 simple movements to reduce pain NOW

Editor’s note: This article first appeared in Clinical Insights newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.

References

1. Mirkin G. Is RICE dead? Why ice delays recovery by Gabe Mirkin MD. Stuartcommunity. Treasure Coast Community Acupuncture. April 12, 2014. https://stuartcommunity.com/rice-dead-ice-delays-recovery-gabe-mirkin-md/
2. Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020;54(2):72-73. doi:10.1136/bjsports-2019-101253
3. Miyazaki A, Kawashima M, Nagata I, et al. Icing after skeletal muscle injury decreases M1 macrophage accumulation and TNF-α expression during the early phase of muscle regeneration in rats. Histochem Cell Biol. 2023;159(1):77-89. doi:10.1007/s00418-022-02143-8
4. Kawashima M, Kawanishi N, Tominaga T, et al. Icing after eccentric contraction-induced muscle damage perturbs the disappearance of necrotic muscle fibers and phenotypic dynamics of macrophages in mice. J Appl Physiol (1985). 2021;130(5):1410-1420. doi:10.1152/japplphysiol.01069.2020
5. Dablainville V, Mornas A, Normand-Gravier T, et al. Muscle regeneration is improved by hot water immersion but unchanged by cold following a simulated musculoskeletal injury in humans. J Physiol. 2025;603(23):7603-7625. doi:10.1113/JP287777
6. Racinais S, Dablainville V, Rousse Y, et al. Cryotherapy for treating soft tissue injuries in sport medicine: a critical review. Br J Sports Med. 2024;58(20):1215-1223. doi:10.1136/bjsports-2024-108304