"Should I Ice it?"

Should I Ice?

Sprained ankle? Ice it. Sore knee after running? Ice it. Wake up with an aching low back? Ice it? We choose to reach for the frozen pea bag with the intent of reducing pain, swelling, and inflammation. Icing has been engrained into our post-exercise and post-injury recovery routine, but is it necessary? Is it helpful, even? This begs some questions about our physiology and what we can do to make the most of it. 

Should we be fighting off inflammation? 

Nope. On a cellular level, our immune system responds to tissue damage in the same way it does to a virus or an infection: with inflammation. Blood vessels open to allow hormones (IGF-1, Insulin-like Growth Factor) to initiate a healing cascade, causing heat and inflammation in a joint. This is similar to having a fever. This process must occur for tissue repair and remodeling to begin. Icing immediately after an injury has even been shown to slow down initial healing. While context definitely matters, most injuries would benefit from gentle movements in replace of ice.

What about swelling? 

It depends. Inflammation is a critical step in our body’s natural healing process. Swelling, in contrast, is an accumulation of waste and fluid from said inflammation, usually a result of insufficient drainage. While swelling is not inherently a negative thing, it can decrease mobility and is often coupled with pain. The best way to flush out swelling is to contract your muscles. This can be accomplished with light range of motion, cardiovascular exercise, or compression with tape or wraps. Again, movement over ice. 

Can icing be detrimental? 

In some cases, prolonged cooling lead to tissue death and permanent nerve damage. Even when applied for 10-20 minutes, icing will temporarily reduce speed, strength, agility and coordination. Also, direct application of ice without a barrier such as a towel or sleeve can cause skin burns and irritation. While trauma from over-icing isn’t our main worry, it’s worth knowing that it could cause harm in certain situations. 

What about the R.I.C.E method? 

In 2015, Dr. Mirkin, who coined the R.I.C.E (Rest, Ice, Compression, Elevation) protocol widely used for treating acute athletic injuries since the 1970’s, recanted his recommendations. Citing decades of scientific journals and articles since then, it was found that ice alone can help improve activity tolerance. However, ice had minimal to no effect on how quickly injuries actually healed, especially when compared to the effects of implementing movement and exercise. He now recommends using ice for less than 10 minutes at a time, and for no longer than six hours post-injury. 

AFTER INJURY, STUDIES RECOMMEND EARLY MOVEMENT AS TOLERATED 

Should I ice to reduce pain after injury? 

Results are mixed when comparing use of ice alone and ice in combination with other therapies. For example, icing for 20 minutes for up to 14 days after an orthopedic surgery has been shown to decrease pain and improve range of motion tolerance. Also, early ice and compression after an ankle sprain followed by initial movement and weight bearing have been linked with less pain and faster return to activity. However, icing alone after an ankle sprain has not demonstrated positive effects on performance. As long as icing is coupled with progressive loading, and not applied for too long, there may be benefit for pain relief and tolerance to treatment.

To sum up... 

Though the research is expansive and often contradictory, the takeaway here is that icing your pain away, though effective short term, is likely not the appropriate long term solution. We should question our reasons for icing, as inflammation and discomfort are not the bad guys. They are signs that our workload has surpassed our body’s current capacity. Warmth and redness indicate healing, just as some soreness after exercise is a good thing because tissues are undergoing repair. Swelling tells us that post-inflammatory waste has built up and is ready to be flushed out. 

Instead of focusing on eliminating the symptoms, we should focus on the root cause. It may be more effective to identify which areas of your training or daily routine can be modified to reduce your risk of injury. Contact your rehab team to better understand your treatment options and to get back to being healthy! 

Allyson Fong, PT, DPT

Allyson is a physical therapist at Kauno

References: 

1. Mirkin, G (2015). Why Ice Delays Recovery 

2. Collins, NC. (2008). Is Ice right? Does Cryotherapy Improve Outcome for Acute Soft Tissue Injury? Journal of Emergency Medicine 

3. Bleakley, C., Costello, J.,& Glasgow, P.(2012). Should Athletes Return to Sport After Applying Ice? Sports Med