The use of ice to treat injuries has become controversial in sports medicine. Gabe Mirkin, MD coined the mnemonic R.I.C.E. (Rest, Ice, Compression, and Elevation), for sports injury first aid in 1978. But he recanted his opinion on ice in 2014. His reversal came after a review of the research which indicated no evidence that ice improves recovery time. Moreover, research suggests that cold therapy can suppress the body’s natural inflammatory stage of healing and reduce blood circulation to the injury.
Inflammation gets a bad rap in the medical community as it is associated with many disease states from cancer to arthritis – this association applies to chronic inflammation, NOT acute inflammation that follows trauma to the tissues. Acute inflammation is a normal healthy response.
The body’s response to ice is as follows: blood vessels constrict to reduce hemorrhage and swelling; nerve endings are numbed to provide pain relief; and, when applied intensely, the painful inflammatory response is suppressed. All three effects reduce pain which is why ice has been a popular home remedy. Giving up the ice does not mean you have to suffer in pain; there are other measures you can take that provide relief and support your natural healing response.
The reduction of hemorrhage, swelling and pain can be accomplished with compression, elevation, and gentle movement. Notice complete “Rest” of injuries (from the R.I.C.E. model) is also in question. Gentle movement helps the body pump dead cells away from the injury and reduce swelling. It also improves circulation of blood to the injured site, bringing healing factors released by your immune system.
Heat also improves circulation to the area but is not recommended the day of injury because increasing circulation to a fresh injury may increase the bleeding in the area. But within hours the bleeding stops, especially when compression is applied, so after that heat is okay and studies indicate it causes no harm.
Over-the-counter pain medicine can reduce the pain, but be wary of the one you choose. Ibuprofen (Advil) is an anti-inflammatory – is that what you want? Acetaminophen (Tylenol) offers pain relief without affecting inflammation. Pain medicines commonly prescribed in emergency rooms are also acetaminophen based.
If your goal is to be back in action as soon as possible, don’t freeze your injury. Instead, take other measures to help yourself heal: start with compression and elevation and after the first day include heat and gentle movement.
(A more thorough article on this topic titled Think twice before applying ice was posted earlier on my blog)