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When someone rolls their ankle, most of us think about applying an ice pack. We even see professional athletes get injured and they are wrapped in ice before they’ve even made it off the field. Ice appears to be an ingrained part of the acute injury management process, but does this align with the latest research?
The earliest documentation of ice as part of the acute injury management protocol dates back to 1978 when the term RICE (Rest, Ice, Compression, Elevation). Ice is used to minimise the inflammatory response in an attempt to accelerate healing. This initial protocol became deeply rooted in our culture and for 20 years we were ‘RICE-ing’ injuries before P was included for protection (PRICE). 14 years later, POLICE (Protection, Optimal Loading, Ice, Compression, Elevation) replaced PRICE.
The reason for the changes?
Research has since identified that ‘Optimal Loading’ (OL) aids recovery through cell regeneration induced by light mechanical loading in the early stages. Subsequently, Rest (R) or a lack of movement is detrimental to recovery.
But what about ice?
There is certainly a consensus throughout the literature that ice acts as a great analgesic (pain numbing agent) by cooling the skin’s temperature. However, the impact on underlying muscles is non-existent, as muscle temperature remains unchanged from topical ice application. Most people report ice makes injuries “feel better”, at least in the short-term. But what impact does immediately icing an injury have in the mid to long-term?
Changes in the research and, as any evidence-based scientist would, retracted ice from their initial protocol. RICE‘ guidelines have been used for decades, but now it appeared that both ice and complete rest may in fact delay healing, instead of helping.
Why doesn't ice exactly help? 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.
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).
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?’
What should I do then?
We encourage you to return to movement safely again, as soon as it is practical.