To Ice or not to Ice?
Icing Injuries: what is the modern thinking on this?
Winter sports season is finally upon us after a long wait due to covid-19.
For the last few years there has been an ongoing debate about how to best manage a fresh injury when it happens. Is icing an injury still the best practice?
Since the 1970’s we have used the RICE (rest, ice, compression, elevation) as the mantra for good acute injury management. It took till 2012 till the practice was questioned and revised to POLICE (protection, optimal load, ice, compression, elevation).
What were we thinking?
The idea of ice was to prevent excessive inflammation, cause vasoconstriction (contraction of blood vessels) to slow bleeding, reduce tissue temperature to reduce the metabolic rate of surrounding tissue avoiding secondary damage, and reducing pain nerve conduction (pain relief).
How has this changed?
Recent scholarly research published in 2019 has called into question the use of ice acutely. Studies have found that applying ice may in fact slow healing. Return to work and sport post-injury in not influenced by application of ice early on. In the immediate time after an injury vasoconstriction (blood vessel constriction) occurs automatically as a protective mechanism of the body to slow the bleeding.
Inflammation that occurs sparks a whole bunch of complex healing processes which in fact speeds the healing process. Over the next few weeks, the body naturally reduces swelling is via the lymphatic circulatory system which is like a plumbing network throughout the body linked to your lymph nodes (glands) where inflammatory fluids are filtered for recycling and waste removed. Interestingly the best way for this system to work is pumping the underlying muscle and breathing. Compression over top of the injury with compression bandages or compression clothing may add value but is limited compared to good muscle contraction.
The idea of “walking it off” may actually have some merit.
As it turns out, once a more serious injury is ruled out with appropriate evaluation by someone like a doctor or physio, gentle movement within reasonable pain tolerance assists in training tissues to heal at their optimal rate. This also improves the vascularization (blood vessel growth) that assists healing. Use of ice and anti-inflammatories therefore seems to slow the optimum healing response.
So, the true value of icing an injury may only be for acute pain relief in the first few minutes and may only be useful to an injured player in the first few moments till the injury can be assessed to figure out the degree of injury and whether an x-ray or similar is needed.
Elevation has also been questioned as to whether it is useful or not, but it has not been thrown out yet as the evidence for it’s use is still unequivocal, so it still may or may not help, but at this stage has not been shown to impede healing.
So what acronym are we using now?
PEACE and LOVE
(Protect, Elevate, Avoid anti-inflammatories, Compress, Load Optimism, Vascularization, Exercise)