For many years it has been conventional wisdom to follow the RICE principles (rest, ice, compression, elevation) following an acute injury like a muscle strain or joint sprain. With respect to applying ice, the rationale has always been that it will limit the extent to which your injured body part becomes inflamed. And if we can minimise inflammation, the thinking is that we will expedite healing and achieve a more rapid recovery and return to normal function and performance following injury. The implication is that the inflammatory response is somehow superfluous to the healing needs of the injury.
For example, you may have received the advice that “inflammation wil help your injury heal… but we don’t want too much inflammation”. If we follow that line of thought, the application of ice is justified on the basis of an attempt to control or limit inflammation to some kind of optimal level for optimal healing. It sounds plausible enough but if this were the case, when we look to the evidence, we would expect to see some benefit in terms of recovery time when ice is utilised.
Interestingly however, when we look at the research that has been carried out to investigate how useful icing an injury is actually is, we find that recovery times are not improved versus control groups. For example, when researchers compare the use of compression on an injury versus the use of ice and compression, there is no added benefit conferred from for applying ice! If our goal is to faster healing of an injury, it is difficult to justify the application ice.
If icing an injury doesn’t help, the next question to consider is… is there any harm in it? Could icing actually hinder your recovery? There is evidence that icing a body part causes restrictions in blood vessels which limits blood flow for up to six hours. Could this hinder tissue healing and slow recovery time? The idea is plausible. Reduced blood flow (from icing)>>> limits delivery of inflammatory mediators to the site of injury>>> injured tissue does not undergo normal rate of healing processes. It is plausible that restricting blood flow might actually impede optimal healing but again, if we look at the evidence, there is no suggestion that using ice delays injury recovery times. So we don’t have evidence that applying ice slows recovery, but we do have evidence that it doesn’t expedite recovery following time injury.
But is it all about recovering faster? We also have evidence that applying ice is useful for controlling pain. And it might be that rapid pain relief is a greater priority for an individual than the overall recovery timeline of the injury. As far options for temporary pain relief are concerned, ice is cheap, safe and convenient. So on one hand we have a useful option for pain relief. And on the other hand, ice might actually hinder optimal healing of an injury, although we don’t have strong evidence to support that possibility. How do we balance these two? One option is to simply find a different pain relief strategy. But if ice is preferred as a pain relief strategy, it makes sense to dose the application of ice. Dr Gabe Mirkin, the doctor who coined the RICE acronym back in the 1970s, suggests that;
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.
My view is that there isn’t definitive evidence to make a strong statement for or against the application of ice to an injury. It is a practice that is so heavily embedded in our culture as “the thing you do” when you injure yourself, that it is difficult to see it going out of fashion any time soon. I think that given we know there is no benefit to applying ice, and there is a plausible risk that it might delay recovery, it makes sense to consider skipping the bag of frozen peas next time to you have sprain or strain problem. We have evidence that you won’t be any worse off for doing so… and you save your peas from thawing out and being ruined..