When injuries strike, the first line treatment that comes to mind for most people is the RICE acronym for rest, ice, compression, and elevation. Initially coined in 1978 by Dr. Gabe Mirken, the belief that ice helps reduce inflammation paved the way for how most people (including physical therapists) treat injuries. But Dr. Mirken has since changed his opinion, stating that ice may actually delay healing. So, is icing sports injuries just an antiquated belief that does more harm than good? Find out here.
The History of Ice for Treating Sports Injuries
Dating back to the 1940s, articles touted how doctors used ice to decrease infection rates, block pain, and reduce the rate of death on amputation surgeries. Yet, the use of ice expanded to be used for all injuries thanks to its ability to dull pain – and it does a great job of relieving it temporarily. But if we want to do more than just dull pain, we need to look at whether the treatment is helping heal the injury.
Fast forward to the 1970s, and Dr. Mirken’s RICE acronym gains popularity in Western medicine, widely believed to alleviate pain, restrict swelling, and reduce inflammation. To this day, most surgeons recommend ice for weeks, if not months, post-surgery to help mitigate inflammation. Inflammation and swelling are normal responses to injury. Normal. So, if the body is meant to become inflamed, should we be stopping it with ice? Some say no. Some say that the long-term damage that can be caused by ice, such as tissue death, outweighs the benefits. In 2014, Dr. Milken withdrew his original statement purporting the use of ice for healing injuries and stated that “subsequent research shows that ice can delay recovery. Mild movement helps tissue heal faster, and the application of cold suppresses the immune responses that start and hasten recovery.”
Why Icing Sports Injuries Isn’t Always the Best Answer When Athletes Want to Return to Sport
If ice slows the healing, it also slows an athlete’s ability to return to their favorite sport. When you get injured, your body’s immune system immediately triggers inflammation to protect the damaged area and start healing. This response is what causes the familiar signs of injury: redness, heat, pain, swelling, and temporary loss of function. Historically, these signs were viewed as negative side effects to be suppressed with ice. However, current research highlights that inflammation is actually a crucial and necessary first step in the body’s three-phase healing process (inflammation, proliferation, and remodeling). During inflammation, vital immune cells clear away damaged tissue, and increased blood flow delivers oxygen and nutrients to the site. This is why many (us included) now believe that suppressing inflammation with ice can actually interfere with the body’s natural ability to heal properly, suggesting that this physiological response is essential for optimal recovery.
Is Swelling Bad?
Healthcare providers often recommend ice for swelling because they believe “excessive” swelling can lead to increased pain and a longer recovery. While it’s true that prolonged swelling can cause problems, swelling itself isn’t inherently bad; it’s a natural and necessary part of the inflammatory response.
When you get injured, blood vessels dilate, and fluid rushes to the area, bringing white blood cells to begin the healing process. This fluid also contains waste from the damaged tissue, and to be cleared, it must be drained through the lymphatic system. Unlike the circulatory system, the lymphatic system is passive and doesn’t have a pump like the heart. It relies on muscle contractions to move fluid. Therefore, the real issue isn’t swelling itself, but rather the failure to properly drain it. Icing sports injuries and resting can hinder this process by reducing the muscle contractions needed to activate the lymphatic system, effectively trapping the debris and slowing down healing.
How to Aid the Recovery Process After Injury
Dr. Chris McKenzie suggests that while icing sports injuries has long been the standard, new research indicates that promoting blood flow is a better way to heal. Inflammation is a natural part of recovery, not a problem to be suppressed. After the first 24 to 48 hours of injury, when ice can be used sparingly for pain (no more than 20 minutes at a time), the focus should shift to treatments that improve circulation. Methods like heat, shockwave therapy, and dry needling help flush out swelling, regenerate healthy tissue, and speed up the healing process. These techniques not only aid recovery but also help reduce pain, offering a more effective approach than simply icing an injury.
Always consult with a healthcare professional to determine the best treatment plan for your specific needs.