Bill Walton’s Multiple Injuries: Why RICE May Not Work

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Bill Walton was a professional basketball player and television sportscaster who was:one of the best college basketball players ever in spite of suffering uncountable injuries requiring 38 significant surgeries. He was elected to the National Collegiate Basketball Hall of Fame in 2006 and won three consecutive national college player of the year awards (1972–1974) while leading UCLA to NCAA championships in 1972 and 1973 during an 88-game winning streak. In spite of his injuries, in his senior year he won the James E. Sullivan Award as the top amateur athlete in the United States.

Walton was selected as the first overall pick in the 1974 NBA draft and he led the Portland Trail Blazers to an NBA championship in 1977 when he, himself, earned the NBA Finals Most Valuable Player Award. The next year, he was the 1978 NBA seasonal Most Valuable Player. He also played for the San Diego / Los Angeles Clippers and the Boston Celtics.

A Basketball Career of Glory and Pain
His list of injuries was frightening. He had almost constant back pain, multiple broken bones, many knee, ankle and foot injuries, several broken hands and wrists, and repeated broken noses.

  • Before his sophomore year in high school, he broke an ankle, a leg, and several bones in his feet, and he had knee surgery.
  • In his junior year in high school, he was unable to complete a full game without being taken out to rest.
  • He was injured late in his junior season at UCLA
  • In his senior year at UCLA, he broke two bones in his back and wore a back brace.
  • In his first two seasons in the NBA in Portland, he had chronic foot injuries including a sprained ankle. He broke his left wrist twice, dislocated two toes, dislocated two fingers and injured his leg in a jeep accident.
  • At age 26, he missed the 1978–79 season because of injuries
  • At age 27 in 1978 playoffs, he broke his left ankle and sat out the entire 1979 season.
  • At age 28 in the 1979-1980 season, he broke his navicular bone and had several surgeries. He missed the 1981 and 1982 seasons.
  • At age 33, in spite of injuries, he was a backup center behind Robert Parish, and earned the “NBA Sixth Man of the Year Award” in the 1985–86 season while helping the Boston Celtics win his second NBA championship.
  • At age 34 and in his final NBA season in 1986–1987, he was injured and played in only 10 games.
  • In 2009 at age 57, he had an eight-hour spinal-fusion, and could not move easily for a year.

From Player to Broadcaster
He said, “I was a very shy, reserved player and a very shy, reserved person. I found a safe place in life in basketball . . . I was a skinny, scrawny guy who stuttered horrendously and couldn’t speak at all.” Yet, after his playing career was over, he went on to become a famous and successful broadcaster as a studio analyst and color commentator over many networks and earned an Emmy Award in 1991for his broadcasting.

The Incredible Genetics of the Walton Family

  • His older brother Bruce was a professional football player who played in the Superbowl.
    His sister Cathy was a youth swimmer and played basketball at the University of California.
  • He also had another brother Andy
    His four sons: Adam played basketball at Louisiana State University, Pomona College and the College of Notre Dame in Belmont, California; Nathan played basketball at Princeton; Luke played in the NBA, and was on the 2009 and 2010 NBA Finals winning Lakers; and Chris was a forward for San Diego State from 2001 to 2005.

Treating Injuries with RICE
When I wrote my best-selling Sportsmedicine Book in 1978, I coined the term RICE (Rest, Ice, Compression, Elevation) for the treatment of athletic injuries (Little Brown and Co., page 94). Injuries and sore muscles have traditionally been treated with ice because it helps to relieve pain caused by injured tissue. Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping (World J Clin Cases, June 16, 2021;9(17): 4116–4122).

In one study, athletes were told to exercise so intensely that they developed severe muscle damage that caused extensive muscle soreness. Although cooling delayed swelling, it did not hasten recovery from this muscle damage (The American J of Sports Med, June 2013). A summary of 22 scientific articles found almost no evidence that ice and compression hastened healing over the use of compression alone, although ice plus exercise may marginally help to heal ankle sprains (The Amer J of Sports Med, January, 2004;32(1):251-261).

Healing Requires Inflammation
When you damage tissue through trauma or develop muscle soreness by exercising very intensely, you heal by using your immunity, the same biological mechanisms that you use to kill germs. This is called inflammation. When germs get into your body, your immunity sends cells and proteins into the infected area to kill the germs. When muscles and other tissues are damaged, your immunity sends the same inflammatory cells to the damaged tissue to promote healing. The responses to both infection and tissue damage use the same cells and chemicals. Inflammatory cells rush to injured tissue to start the healing process (Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999). The inflammatory cells called macrophages release a hormone called Insulin-like growth Factor-1 (IGF-1) into the damaged tissues, which helps muscles and other injured parts to heal. However, applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1 (Journal of Applied Physiology, July. 2019;127(1):47-57)

The authors of one study used two groups of mice, with one group genetically altered so they could not form the normally expected inflammatory response to injury. The other group was able to respond normally. The scientists then injected barium chloride into muscles to damage them. The muscles of the mice that could not form the expected immune response to injury did not heal, while mice with normal immunities healed quickly. The mice that healed had very large amounts of IGF-1 in their damaged muscles, while the mice that could not heal had almost no IGF-1. (Fed of American Soc for Experimental Biology, November 2010).

Ice Keeps Healing Cells from Entering Injured Tissue
Applying ice to injured tissue causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation (Knee Surg Sports Traumatol Arthrosc, published online Feb 23, 2014). The blood vessels do not open again for many hours after the ice was applied. If ice is applied to an injury too long, this decreased blood flow can cause the tissue to die from decreased blood flow and can even cause permanent nerve damage.

Anything That Reduces Inflammation Also Delays Healing
Anything else that blocks the immune response to injury also can reduce strength, speed, endurance and coordination, including:

• cortisone-type drugs

almost all pain-relieving medicines, such as non-steroidal anti-inflammatory drugs like ibuprofen (Pharmaceuticals, 2010;3(5)),

immune suppressants that may be used to treat arthritis, cancer or psoriasis,

ice or cold packs

Ice may be used as short-term treatment to help injured athletes get back into a game (Sports Med, Nov 28, 2011), and the cooling may help to decrease pain, but it interferes with the athlete’s strength, speed, endurance and coordination. A search of the medical literature found 35 studies on the effects of cooling, and most reported that immediately after cooling, there was a decrease in strength, speed, power and agility-based running. A short re-warming period returned the strength, speed and coordination. The authors recommend that if cooling is done at all to limit swelling, it should be done for less than five minutes, followed by progressive warming prior to returning to play.

My Recommendations
If you are injured, stop exercising immediately. If the pain is severe, if you are unable to move or if you are confused or lose even momentary consciousness, you should be checked to see if you require emergency medical attention. Open wounds should be cleaned and checked. If possible, elevate the injured part to use gravity to help minimize swelling. A person experienced in treating sports injuries should determine that no bones are broken and that movement will not increase damage. If the injury is limited to muscles or other soft tissue, a doctor, trainer or coach may apply a compression bandage. Since applying ice to an injury has been shown to reduce pain, it is acceptable to cool an injured part for short periods soon after the injury occurs. You could apply the ice for up to 10 minutes, remove it for 20 minutes, and repeat the 10 minute application once or twice. There is no reason to apply ice more than six hours after you have injured yourself.

If the injury is severe, follow your doctor’s advice on rehabilitation. With minor injuries, you can usually begin rehabilitation the next day. You can move and use the injured part as long as the movement does not increase the pain and discomfort. Get back to your sport as soon as you can do so without pain.

William Walton III
November 5, 1952 – May 27, 2024