Early Load Anti-RICE Protocol
Use gentle pain-free loading to preserve tissue direction and move inflammatory fluid
- Difficulty
- Moderate
- Time to result
- ~days to results
- Steps
- 5
- Confidence
- 97%
Baar argues that complete unloading can worsen tendon and ligament healing because the tissue loses the directional signal supplied by tension. His alternative is not full activity but early, protected, low-jerk loading. In a safe position, develop a small amount of force slowly, keep the action pain-free, hold, and release slowly. After surgery, the position must account for the repair; he uses the example of loading a repaired Achilles in a shortened, plantar-flexed position so reinforced sutures do not take all the force. For swelling, he uses brief contractions or controlled movement to squeeze fluid from connective tissue rather than suppressing the whole inflammatory response with ice or medication. The protocol requires medical collaboration because the allowable load depends on the injury.
Origin
Baar contrasts stress-shielding experiments and early-loading studies with the long-standing rest, ice, compression, elevation approach to orthopedic injuries.
Core principles
- 01Removing all tension stress-shields injured tissue and can promote disorganized scar
- 02A small pain-free load can tell new collagen which direction to follow
- 03Load can move fluid without globally suppressing the inflammatory response
- 04Develop and release force slowly to minimize jerk
- 05Medical constraints determine which positions and loads are safe after surgery
How to run it
- 1
Establish the protected range
Work with the treating team to identify a position where the repaired or injured native tissue can receive light tension without threatening the repair.
Pro tip For a repaired Achilles, Baar discusses a shortened, plantar-flexed position and both bent- and straight-knee loading.
Watch out Suture type and placement can change where the load goes.
- 2
Apply a small signal
Develop only enough force to feel gentle tension across the area, with no sharp pulling or pain.
Pro tip The goal is to keep the native tissue active, not to test its strength.
Watch out Do not turn early loading into a maximal contraction.
- 3
Control both transitions
Build force over several seconds, hold in the protected position, and let the force off over several seconds.
Pro tip A boot may sometimes remain on while pressing gently into it, depending on clinical instructions.
Watch out Rapid loading introduces jerk and can defeat the protective intent.
- 4
Repeat the loading dose
When clinically appropriate, complete four 30-second holds and repeat the short session later rather than remaining unloaded all day.
Pro tip Baar describes morning and evening loading around periods in the boot.
Watch out The exact timing after surgery is a medical decision, not a universal prescription.
- 5
Pump excess fluid
Use brief isometric holds or controlled movements to contract muscles and squeeze fluid from the injured region.
Pro tip After an ankle sprain, Baar traces capital letters with his toes to keep gentle load moving through the tissues.
Watch out Do not use movement that reproduces sharp, localized pain.
In the wild
Baar describes a study of patients who began loading either two or nine days after injury. He reports that the day-two group returned to sport 25 percent faster.
→ Earlier controlled loading was associated with a faster return to sport in the study he cites.
Baar says that immediately after twisting an ankle, he traces capital letters with his toes and uses repeated gentle loading to move fluid through the injured tendons and ligaments.
→ In his personal example, bruising remained the next day but the ankle returned to normal size and he could run.
Common mistakes
Treating the boot as neutral
A boot protects a repair but also mechanically stress-shields the tissue, so Baar argues for controlled loading periods when permitted.
Confusing early load with full load
The protocol uses a small, controlled signal and does not call for immediate unrestricted activity.
Suppressing every inflammatory signal
Baar says inflammation is required for adaptation and favors targeted fluid movement over globally turning it off.
Is it for you?
Best for
Early rehabilitation directed by a clinician who can account for the specific injury, repair, sutures, and protected range.
Not ideal for
Fractures, unstable repairs, unknown injuries, or any case where a treating professional has not approved the proposed load.
From the transcript
“The ones that they loaded at day two after the injury, they got back 25% faster than the ones that they loaded at 9 days.”
“I understand that you cannot put full load on a surgical repair immediately.”
“I am not going to use anti-inflammatories that are pharmaceuticals or other things. I am going to use load as an anti-inflammatory.”
From the episode
#797: Dr. Keith Baar, UC Davis — Simple Exercises That Can Repair Tendons (Tennis Elbow, etc.), Collagen Fact vs. Fiction, Isometrics vs. Eccentrics, JAK Inhibitors, Growth Hormone vs. IGF-1, The Anti-RICE Protocol, and How to Use Load as an Anti-Inflammatory
Keith Baar