Heather Bedard, C.H.E.
As with many things in the healthcare (aka sickcare) industry that we have around us today, there are sage words of advice that we find maybe aren’t so sage after all. One of the most prominent on my mind currently, is the advice to ice an injury. A recent knee injury brought this to the forefront of my mind, so I decided to do some research on the topic. What I found surprised me and flies in the face of the prevailing advice of pretty much every person, doctor, or chiropractor I have spoken to. While I am not any one of the latter, you can bring what you read here to your doc, if the situation allows, and see if they have any insight. In this article, I am not going to be talking about using ice for major acute injuries or injuries in which swelling is affecting blood flow to the tissue. I am mostly addressing your generic sprained ankle, knee tweak, and strains.
The reason most people advise using ice on an injury is to make the pain more bearable and reduce the swelling. While numbing the area for a moment may seem to reduce the pain for a moment, it really does nothing for the long-term pain, or pain that is experienced as soon as the ice is removed. Additionally, not all swelling is bad! The swelling helps to bring white blood cells to the injured area, release IGF-1 to facilitate the killing of damaged tissue, remove debris, and relax the blood vessels to help to provide nutrients and oxygen. Interfering in this process may extend your healing time by inhibiting these processes from happening.[1]
Additionally, we know that the skin must reach 57.92 degrees Fahrenheit to eliminate pain and 56.84 degrees to reduce blood flow and achieve any therapeutic benefits from the cold. In many cases you will be unable to get the skin temperature below 64.22 degrees without running the risk of inducing damage from prolonged cold exposure. So, if we know this to be true, how did we get here?
Officially, in 1978, a man named Dr. Mirkin wrote a book titled “Sports Medicine” and introduce the concept of RICE (Rest, Ice, Compression, and Elevation). Over the years since then, the standard practice moved from PRICE to POLICE to PEACE & LOVE. As of 2019, you will notice that ice no longer remains the standard protocol and randomized control trials are few and far between. The ones we do have do not conclusively find that ice should be used in the acute treatment of ankle sprains.[2]
Different injuries of the muscles, tendons, and ligaments require differing healing times as well as treatment protocols. You should always approach this by taking in the risk vs reward ratio for the treatment of your particular injury. I think it is always good to keep in mind that your body knows what you need, and it is beautifully designed to heal itself. The less we can interfere with that process and allow the body to do what it needs to do, the better.
The next time that you, or someone you love, gets injured, maybe we should rethink the recommendation to ice, ice, baby.
--------------------
[1] Wang ZR, Ni GX. Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture?. World J Clin Cases. 2021;9(17):4116-4122. doi:10.12998/wjcc.v9.i17.4116
[2] van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?. J Athl Train. 2012;47(4):435-443. doi:10.4085/1062-6050-47.4.14