To Ice or Not to Ice An Injury?

Ice has been a common initial injury technique used among many when an injury first appears. When someone rolls their ankle, most of us instinctively grab an ice pack. When we see professional athletes get injured, they’re wrapped in ice before they’ve even made it off the field. But the question lies should we be applying ice immediately after sustaining an injury or not? 

The earliest documentation of ice as part of the acute injury management protocol dates back to 1978 with the term RICE (Rest, Ice, Compression, Elevation). The intention behind using ice was to minimise the inflammatory response to accelerate healing (1).  

However, based on new research it identified that by resting the injured site, the lack of movement is detrimental to recovery and delaying the recovery process. A study in 2014 (3) found that using ICE and rest may in fact delay initial healing, instead of helping. By applying ice immediately to the injury, it is preventing the body’s natural release of inflammatory cells, which then delays the initiation of healing (2).

Therefore, early optimal loading aids in recovery to the injured site for a quicker recovery.

In 2019 the latest and most comprehensive acute injury management technique is PEACE & LOVE (Protection, Elevation, Avoid Anti-Inflammatory Drugs, Compression, Education & Load, Optimism, Vascularisation and Exercise). This moves from resting the injury, to instead now encouraging early optimal loading to aid in the recovery through cell regeneration by light mechanical loading in the early stages (3) 

With all of this new-found evidence on the negatives of icing injuries, it begs the question: 

‘If ice delays healing, even if it can temporarily numb pain, should we still be using it?’ 

There is certainly a consensus throughout the literature that ice acts as a pain numbing agent by cooling the skin’s temperature. However, the impact on underlying muscles is non-existent, as muscle temperature remains unchanged. The only exception to this rule would be when injuries are severe and in circumstances where swelling will likely be the limiting factor for recovery such a severe joint sprain (ankle sprain) where it is limiting range of movement- then application of ice is warranted (4).  

Otherwise, for now, based on current research keep the ice in the freezer as we now understand ice is less important than we once thought (5).  

References 

1. Scott, A., Khan, K. M., et al. (2004). What do we mean by the term “inflammation”? A contemporary basic science update for sports medicine. British Journal of Sports Medicine. 38, 372–380. 

1. Mirkin, G. & Hoffman, M. (1978). The sportsmedicine book. (1st ed.). Little Brown and Co. 

1. Mirkin, G. (2014, March 16). Why Ice Delays Recovery. https://www.drmirkin.com/fitness/why-ice-delays-recovery.html 

1. Palmieri, R. M., Ingersoll, C. D., et al. (2004). Arthrogenic muscle response to a simulated ankle joint effusion. British Journal of Sports Medicine. 38, 26–30 

1. Z. Wood (2021). To Ice or Not To Ice An Injury. https://www.physio-network.com/blog/ice-for-acute-injury/