Ice Packs: Do They Do More Harm Than Good?
The RICE method (Rest, Ice, Compression, Elevation) is a well known mnemonic in every-day life. This has been the common practice since the 1970s. If there is a musculoskeletal injury, the immediate response is to still whip out an ice pack. The thought is that ice will reduce the inflammatory response and inhibit swelling in the area so that movement can be maintained and pain will be better managed. The next step people do is to rest and completely stay off that limb or joint for a few days. Compression and elevation, although the most important part of this old mnemonic are often overlooked in actual practice.
What research is showing is that immediately icing the injured area and then not using it can actually delay healing. Our bodies have created an amazing defense mechanism and repair process in the form of inflammation. That swelling (inflammation) that you see in your sprained ankle includes many cells called macrophages. These cells rid the area of damaged tissue. They also release the hormone insulin like Growth Factor (IGF-1) which helps to repair tissue. When we put ice on this area, we restrict the amount of inflammation that can get into the injury and thus we restrict the repair process. We also do not want to completely rest the injured area. We want to make sure we are protecting the area, but through light loading of the injured tissue, our body will continue to release hormones and molecules that aid in cell regeneration.
So is there ever a place for ice in the recovery process? Not really. Research has shown that ice slows down the inflammatory response and overall recovery. It does help with pain in the short term but the benefits do not seem to outweigh the risks. Ice can be used in the chronic stages (more than 3 weeks after injury) in instances of chronic inflammation. Inflammation is meant to be temporary so if we are having chronic inflammation, we then have the option to use anti-inflammatories and/or ice.
Although not quite as catchy, there is now a new mnemonic that is trying to take root for the management of acute injuries. PEACE & LOVE (Protection, Elevation, Avoid Anti-Inflammatories, Compression, Education, & Load, Optimization, Vascularization, and Exercise). My personal opinion is that the mnemonic still needs some work to ever become ingrained in popular culture. The main takeaway of this blog: Don’t ice your injuries. It does more harm than good.
Shannon Hall, PT, DPT