Why icing an injury might not be the best thing anymore for recovery

peace and loveThe term R.I.C.E is widely known when dealing with sporting injuries. It’s usually taught in school P.E class and then is carried on throughout life without a second guess. Even most GP’s are still using this acronym when giving advice to people who may come into their clinic with sprains and strains. But if you have been to a physio recently for an injury as such, you may have been told to ditch the acronym. Before we get into the why, let’s define R.I.C.E and decipher when, if at all, it has a role to play in injury management. I am going to use the humble low grade ankle sprain as the example here as it’s a common injury and one that’s most easy applied in this situation:

R-Rest. Rest the ankle by not weight bearing on it. Use crutches if you need to help with walking

I –Ice. Apply ice immediately and continue to do as long as the swelling continues

C- Compression. Apply a compression garment such as a tubigrip or bandage

E- Elevation. Elevate the ankle above heart level to help with swelling

Some of you may be thinking, well – what’s wrong with that?? Makes sense doesn’t it? It used to, but the most recent research is actually showing the opposite is true. You see ice was once so widely used to help with swelling and pain, because the ice actually helps in numbing the pain. What we didn’t know until fairly recently though, is that ice application actually hinders the natural healing process. When we injure ourselves, our body sends signals out to our inflammatory cells (macrophages) which release the hormone Insulin-like Growth Factor (IGF-1). These cells initiate healing by killing off damaged tissue. Although when ice is applied, we may actually be preventing the body’s natural release of IGF-1 and therefore delaying the initiation of the healing process. The only exception to this rule change, is when the injury is severe enough and the oedema (swelling) is impacting greatly on the range of motion of the joint. Applying ice in this situation may be beneficial as we want to avoid restricting the joint range of motion for long periods.

Ice was finally revoked in 2019 from the injury management process with the latest and most comprehensive acronym: PEACE & LOVE (Protection, Elevation, Avoid Anti-Inflammatory Drugs, Compression, Education & Load, Optimism, Vascularisation and Exercise)

I won’t go through that whole acronym but let’s focus on a few key points which may be the most interesting from a physiotherapy perspective:

L – Load. Research has since identified that ‘Loading’ an injury such as an ankle sprain, aids recovery through cell regeneration induced by light mechanical loading in the early stages. Conversely, rest or a lack of movement is detrimental to recovery.

This may be why when you have come into our clinic with an ankle sprain and struggling with crutches, we tell you to ditch them and start walking straight away.

E – Exercise. Gentle movement and the appropriate exercises are much more beneficial to recovery and will prevent any long-lasting restrictions with range of motion and strength.

So next time you have a sporting injury, it may be wise to actually leave the frozen peas in the freezer and instead seek out some advice from your physio about how best to manage the swelling and pain with load and exercise instead.