To Ice Or Not To Ice? – How to recover quickly from injury

Ice therapy has been the gold standard for the treatment of acute injury since its introduction in 1978 in the book Sportsmedicine. Gabe Mirkin was the man who pioneered its use in combination with rest, compression and elevation otherwise known as RICE.

But why do you ice? What is the theory behind it?

The aim of Ice Therapy is to reduce inflammation by constricting the blood vessels. This leads to a reduction in pain (gate control theory), reduction in muscle spasm and a reduction in oedema.

Sounds pretty sensible right? You hurt yourself, get an ice pack.

But surely the human body knows better? What makes us think that inhibiting a natural response to injury is more beneficial?

For starters if you cut yourself how does it heal? if you have an infection how do you get better? The body’s response to injury is inflammatory because it is normal healthy physiology; it is BLOOD that carries a whole army of cells and chemicals to go to work and fix the problem.

The advice now for an ankle sprain is not RICE (rest, ice, compression and elevation) but compression and elevation and to get it moving as quickly as possible as focusing on drainage is key. Icing an area reduces blood flow therefore reducing the effectiveness of the inflammatory response, meaning it will take longer to get better.

So what about our friend Gabe? Well thankfully back in 2015 he did a 180 and is now an advocate against the use of ice. He said I was wrong and “we should stop using Ice as part of the protocol and really just focus on the “CE” but with movement added in!”

What is the evidence?

There is not much quality evidence (Randomised Clinical Trails – RCT) to support the use of ice for musculoskeletal injury or for the treatment of DOMS (delayed onset muscle soreness). In fact an article in in Sports Medicine; November 28, 2011 found that icing for 20 minutes led to a decrease in strength, speed and power in agility based running.

There is still limited evidence but a RCT published in Postgraduate Medicine 2015 showed that heat acts as an analgesic (painkiller), leads to increased blood flow, increased metabolism and elasticity of connective tissues. It decreased pain in acute low back pain and in the use of DOMS.

So how to treat an acute injury?

  1. The use of heat will cause vasodilation, allowing blood to flow to the area carrying with it all good stuff to make us better.
    (Please note that over-application of heat will not heal you faster but will exhaust the reflexes of the nervous system rendering them inactive). 
    Depending on the site of the injury heat can be applied for 15-20 minutes and can repeated.
    There are contraindications to heat, if you have loss of sensation, circulatory problems or DVT.
  2. Get it moving and gradually load the tissues pain free, as drainage is important. Muscular contraction helps move the fluid with its waste products out of the area and back into main circulation.

Obviously if the injury is traumatic and there has been some concussion, there is an open wound or possibility of fracture a visit to A&E is recommended.

If you have had an injury that has not fully resolved or that comes back again and again, please contact us to find out how Vanessa can help.