Should We Apply Ice For Injuries?

At some point in your life, somebody like a parent, coach, therapist or doctor has recommended that you go home and apply ice to a fresh injury.

Perhaps you sprained your ankle.  Pulled a muscle in your back.  Had a flare up of arthritis in your knee.

And you followed the recommendation and applied a bag of ice cubes or a bag of frozen peas over the affected area.  Did it help you?  Did you feel like your recovered quicker?

The reality is that over 40 years, there has not been any compelling scientific research that shows icing or cold therapy helps injuries heal faster.  In fact, new research now claims that perhaps ice even slows down your recovery!

But why not?  After all, doesn’t a cold pack on an injury help restrict blood flow to the injured area, numb the pain, and control the swelling?  Aren’t these good things?!

As a practising chiropractor for over 13 years, I too have been guilty of making this recommendation to my patients and over the past year have reduced my recommendation for using ice significantly.  It was what we learned in school, it was commonly used in hospitals and clinics around the world, the R.I.C.E. principle has been around since the 1970s and it just seemed to make sense.

But if we look at the available research on the topic of icing, there actually isn’t much solid evidence of its efficacy for injuries.  And in fact, some of the new research seems to suggest that icing may actually DELAY recovery.

Interestingly enough, even the person that coined the R.I.C.E. principle, Dr. Gabe Mirkin who is a sports medicine doctor and professor at the University of Maryland, has changed his tune, admitting that ice is no longer a good idea.  Bed rest has been debunked for some time now and it’s now relative rest instead where one should avoid strenuous aggravating activity but still engage in active, light movement.

Ice may be bad because it blocks the human body’s natural healing mechanism: inflammation.

We are naturally inclined to think that inflammation and swelling is bad.  After all, we’ve been icing injuries and taking ANTI-inflammatory medications for decades!

But inflammation and swelling is an essential part of healing in the body.  In fact, it is the first step in the scientifically recognized 3 Stages of Healing: Inflammation, Tissue Repair, Remodelling.  Any time a muscle or any other tissue injury occurs, your immune system sends inflammatory cells called macrophages which release a substance called IGF-1 (insulin growth factor) to the damaged area to kick start the healing process.  However, when ice is applied, the arrival of macrophages is delayed, which in turn means that the normal first stage of healing mechanism is delayed.

Post-injury, local redness and heat are caused by increased blood flow. Swelling is the result of the increased movement of fluid and white blood cells into the area of inflammation.  So we actually want these things to occur not inhibit them!

This also means that commonly prescribed and over-the-counter medications like corticosteroids and Ibuprofen which suppress the immune system and inflammation, actually BLOCK healing.

Over the past 12 months, I’ve been changing my tune with patients too and encouraging them to follow a Movement, Elevation, Traction, Compression and Heat or M.E.T.C.H. principle.

For example, if you sprain your ankle:

  1. perform regular light range of motion exercises with the foot,
  2. keep it elevated,
  3. have someone gently stretch out (traction) the ankle joint,
  4. compress it with either elastic tubing, a TENSOR bandage or compression socks and
  5. consider applying heat for short intervals instead.

So while ice may still serve a purpose in dealing with pain, it may be doing an overall disservice by increasing your time for recovery.

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