Ice ice…maybe?

One of the common questions we get asked in clinical practice is: “Should I use ice for my symptoms?” Today we’re here to find out during ice-olation (couldn’t resist, not sorry) – Say Yes to the Ice or, Ice ice…maybe?

The application of cold or ice therapy to assist with injury healing or condition management has been employed for many years. A lot of our patients recall the RICE and PRICE acronyms that have been used as a reminder of how to immediately deal with acute soft tissue injuries. For avoidance of doubt, this is: P – Protect, R – Rest, I – Ice, C – Compression, E – Elevate.

Some of you might have even watched PRICE graduate to POLICE, where Rest was switched to Optimal Loading in light of evidence that smart progressive loading of the injured tissues based on the symptoms tolerated by the individual lead to improved healing rates and quality.

One of the limitations of these acronyms is the idea that this only covers the immediate stages of an injury and doesn’t account for the short or long term management. Furthermore, and ironically enough, the evidence for the use of ice to manage these symptoms was…well, on thin ice.

In 2019, Blaise Dubois and JF Esculier launched an updated, evidence-based acronym called PEACE & LOVE which also considers the longer-term management of symptoms to maximise healing and recovery potential. We’ll talk through this later this week, but the most glaring and deliberate omission from this was ice. So why might it be a case of ice ice…maybe?

There are a growing number of research studies highlighting that using ice has the potential to negatively affect the natural healing process of tissues. By disturbing the initial stages of inflammation, this can result in poorly-formed tissue and an impaired recovery, regardless of the efforts of any rehabilitation programme. Consideration should therefore be given over whether ice is used in any immediate soft tissue management, even if for pain relief.

However, life is not always that simple. Sometimes injuries can be very painful and pain needs to be brought under control, either from the injured tissue or from the pressure of the swelling itself. The swelling around injured or damaged tissues can be thought of as the body’s own way to support a weakened structure. Think of an ankle sprain with less stability following a ligament tear – the swelling helps to provide some temporary stability.

Although anti-inflammatory medications such as ibuprofen are not advised within the first 48 hours (or at all if possible), ice could be one possible solution. Other pain relief medication can be used to help here such as paracetamol. But what if someone cannot take this medication for health reasons or personal beliefs?

This can change completely if we switch our focus from soft tissue injuries to people who have undergone some surgeries such as ACL reconstructions or joint replacements. Oftentimes, the swelling can lead to restricted motion. If this is not controlled properly, it might limit the success of the operation. There is need to restore motion as soon as possible for adequate loading of the tissues, and to progress through the various stages of rehabilitation.

Furthermore, people with inflammatory joint conditions such as arthritis may need to manage their pain and swelling is necessary in order to minimise the negative impact the condition has on their quality of living, taking whatever measures are available to them to help them such as ice.

So…should you use ice? The answer really is ice ice…maybe – it depends. Every person and every circumstance is different. We are here to present all options and help educate you on the benefits and risks of each one. Hopefully you can see some of the considerations that must be taken into account. If you are unsure and would like specific and detailed advice on how this affects you and your condition or injury, don’t hesitate to get in touch and ask us!

Core Reading:

Doherty C, Bleakley C, Delahunt E, et al. Treatment and prevention of acute and recurrent ankle sprain: An overview of systematic reviews with meta-analysis. Br J Sports Med (2017);51: 113-25.

Singh DP, Barani Lonbani Z, Woodruff MA, et al. Effects of topical icing on inflammation, angiogenesis, revascularization, and myofiber regeneration in skeletal muscle following contusion injury. Front Physiol(2017);8: 93.

van den Bekerom MPJ, Struijs PAA, Blankevoort L, et al. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults. J Athl Train(2012);47: 435-43.

Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: Update of an evidence-based clinical guideline. Br J Sports Med(2018);52: 956

Yerhot P, Stensrud T, Wienkers B, et al. The efficacy of cryotherapy for improving functional outcomes following lateral ankle sprains. Ann Sports Med Res(2015);2: 1015.