De-ICED: Weaning Athletic Trainers off Their Dependency on Rest-Ice-Compression

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This presentation was recorded at NATA 2022 in Philadelphia and featured in our 2023 Encore.

Abstract:
Rest, ice, compression, elevation (RICE) was a term first introduced in 1978 by Dr. Gabe Mirkin as the treatment of choice for acute sports injuries. RICE has become a cornerstone of acute therapies in athletic training for decades, yet the evidence supporting its usage and effectiveness has been inconsistent and, in some instances, controversial. In fact, rest, ice and compression may actually delay the healing process and become an impediment to the natural inflammatory process. The shift to mild movement (passive, active-assisted, active) helps to heal tissues faster and facilitate the body’s own immune responses in support of the inflammatory mechanisms. While ice, such as cryotherapy, has shown some analgesic benefits, active recovery involving movement to assist the body’s own natural healing mechanism is becoming better understood and use in sports health care emerging. The phrase “just ice it” is taking on a completely new meaning in sport-injury care circles in the 21st century and athletic trainers have a very influential role in creating the contemporary changes taking place. The purpose of this session is to provide athletic trainers with a historical look at RICE in treating athletic injuries, provide counter arguments against RICE based on solid scientific and medical evidence and provide alternative treatment solutions involving active recovery that will benefit athletic trainers in a variety of clinical settings.

Learning Objectives:

  • Gain knowledge and understanding of the concept of acute injury inflammation from a treatment intervention perspective
  • Distinguish and comprehend which physiological processes and systems (circulatory, immune, lymphatic, musculoskeletal) that are most important in acute sport-injury management
  • Review the history of RICE in acute sport-injury management and decode the myths associated with rest, ice and compression, especially the concept of “secondary cellular death,” by using contemporary evidence-based research and offer alternative solutions to athletic trainers involved in acute sport-injury management
  • Gain a greater appreciation/understanding for tissue preservation and regeneration, along with the functional restorative processes in the human body
  • Gain a greater understanding of the importance of active (controlled) movement post-acute injury and the timetable and benchmarks for promoting treatment progression

Level:
Advanced

Domain(s):

  • Domain 3: Critical Incident Management
  • Domain 4: Therapeutic Intervention

CEUs:
1.0 Category A

Keywords: preservation, cryotherapy, regeneration, ice, RICE, 

On-Demand (Enhanced Access) Course Expiration:
Courses registered for after February 5, 2025, must be completed by December 31, 2025, at 11:59 p.m. CST.
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Thomas Kaminski, PhD, ATC, FNATA

Thomas W. Kaminski, PhD, ATC is currently Professor and Director of Athletic Training Education at the University of Delaware. He graduated from Marietta (Ohio) College with a BS degree in Sports Medicine in 1984, completed his MS degree in Exercise & Sport Science from the University of Arizona in 1985, and earned his PhD in Sports Medicine from the University of Virginia in 1996. Tom has the distinct honor of holding fellowship status in the National Academy of Kinesiology (NAK), American College of Sports Medicine FACSM), National Athletic Trainers’ Association (FNATA), and the Research Consortium of the Society of Health and Physical Educators’ (SHAPE America) (RFSA). Most recently he was inducted into the Eastern Athletic Trainers’ Association (EATA) prestigious 49’ Club (Hall of Fame). In addition, he was selected as the National Athletic Trainers Association (NATA) Education Council Sayers "Bud" Miller Distinguished Educator Award, June 2010; National Athletic Trainers Association (NATA) Most Distinguished Athletic Trainer Award, June 2014; and most recently National Athletic Trainers Association (NATA) Research and Education Foundation 2016 NATA Foundation Medal for Distinguished Athletic Training Research. In 2018 he was named Most Distinguished Alumnus by the Marietta College Alumni Association. Dr. Kaminski has served the NATA, EATA, DATA, SEATA, ACSM, SHAPE America and other professional organizations in many capacities during his 35+ year career as an athletic training administrator, clinician, researcher, and educator. His peer-reviewed journal publications (150+) have appeared in many discipline specific journals including the American Journal of Sports Medicine, Journal of Athletic Training, Journal of Orthopedic and Sports Physical Therapy, Medicine & Science in Sports and Exercise, and the Archives of Physical Medicine and Rehabilitation. He was the founding editor of the SLACK, Inc. journal titled Athletic Training & Sports Health Care (13 year rein) and currently serves on many editorial boards. He is a member of the Professional Development Committee of the NATA and serves on the Medical Advisory Board for Footbeat/Avex LLC. He is a co-founder of the International Ankle Consortium (IAC) and serves to plan the triennial International Ankle Symposium. In addition to his research interest with ankle instability, Dr. Kaminski is a leading expert on issues related to purposeful heading in soccer and maintains a database established in 1998 examining purposeful headers in interscholastic and intercollegiate soccer during this time. He and his colleague Dr. Thomas Buckley (University of Delaware) were co-PI’s on the landmark NCAA/DoD CARE Consortium project examining the natural history of concussion in intercollegiate sports at the University of Delaware from 2015-2021. Dr. Kaminski has also partnered with the United States Soccer Federation (US Soccer) and the United Soccer Coaches association to insure that youth soccer participants are safe, especially during purposeful heading of a soccer ball.

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