Get Icy?

By: Chad Burnham, DPT, FAFS, CSCS

To Ice Or Not To Ice

For the longest time we have all been told to ice our injuries, aches, and pains. You all know the famous acronym RICE (Rest, Ice Compression, Elevation). I first made this mistake early on in my career as we did not know any better. It was not for a lack of knowledge, but more a lack of research.

So why are we as medical or fitness professionals continuing to recommend RICE as your first source of treatment after an injury? Is this still accurate based on the research?

As previously discussed in our last episode on In The RACK Podcast we talked about the acronym RICE and if it still holds true. RICE was first developed by Dr. Gabe Mirkin in 1978. The funny thing is, he actually came back out in 2014 and admitted he was wrong regarding the “ice” portion of his RICE acronym.

So should we still be using ice?

Well, let’s just say that there is plenty of research demonstrating how ice can help reduce pain and discomfort. Studies have even shown that there is a high compliance and patient satisfaction with ice . This is most likely because we’ve been conditioned to think it’s good…Maybe it’s mental lol.

What we will say is that ice does have its place and does serve a purpose. Most people would say that ice following an injury makes everything feel better. This is mainly because ice provides an analgesic effect.

But doesn’t  ice reduces inflammation?

Beides the fact that ice has actually not been shown to reduce inflammation, the question we need to ask is do we want to actually mitigate inflammation?

Let’s talk about healing! So inflammation is a natural protective process, in which the body sends healing factors (macrophages) to the area of injury to get rid of the bad stuff (damaged tissue) and start building back the new stuff. If we stop that process we will actually delay the healing process. This is also true for medications like cortisone. Which can actually impair healing and predispose you to certain injuries, like tendinopathies and ruptures.

Where do we draw the line in the sand?

This is a good question, because based on the research, there has been no research to support ice helping to heal an injury. In fact, ice has actually been shown to reduce the opening of blood vessels (vasoconstriction) around the site for hours after use. In other words, so you’re not just impairing healing while icing, but for hours and potentially days following.

There has been some research on ice combined with exercise can enhance outcomes, but it may just be that the warming of the tissues from movement trumps the cold stimulus. This is why we would normally recommend gently moving the injured area of the body (obviously as long as fractures ruled out, or any injuries where movement could cause further damage).

Ok…if not ice then what?

If you are acutely injured and inflammation seems excessive, trying elevating the injured area first instead of icing. Movement will be your best friend. Start with gentle, less painful movement, and gradually increase (Remember, no moving unstable/broken body parts - see a doctor for these).

For chronic injuries or for personal preference, limit your amount of time you use ice. As we discussed, its function is truly only for pain analgesia. That will often occur in the first few minutes of application, so no need to ice any longer than 10 minutes really!!!

So…If using ice post-injury, forget about it! Unless the injury is so severe that the inflammation is restricting blood flow to the rest of the limb or compressing nerves causing significant numbness. Otherwise, leave the ice in the freezer!

For a deeper dive into ice check out our upcoming podcast In The RACK Podcast episode 9. We talk all things ice and even talk about cold exposure for all of you that are into that sort of thing lol.