How Effective is Ice on an Injury?

Recently an article was published on the MacLean’s website discussing the controversial topic of whether or not using ice helps an injury.

http://www.macleans.ca/society/the-end-of-the-ice-age/

Here is what we think and why we choose to use it when we do:

So right off the bat, I want to say that there is no right answer for this in all situations and has a lot of moving parts. This is one of those debates where like the article says research is inconsistent. What we do know is that when ice is applied to a specific body part vasodilation initially occurs (more blood to the area) to try to warm the area for a period of about 5 min. After this, there is a period of vasoconstriction (less blood flow to the area) that lasts for about 20 min. After this occurs vasodilation returns but to a net amount that is less than prior to ice. This is known as the Hunting response and is why we choose to not ice for longer then 20 min for risk of frostbite. Now we define swelling and inflammation. In a simple sense inflammation is a process and swelling is a result. When an infection, allergic reaction or acute physiological damage occurs the body has an inflammatory response that occurs to combat these changes to our homeostasis and bring nutrients to the area. The accumulation of byproducts from this process is swelling. In infection this can cause blood flow restrictions to body parts, in allergic reactions this can cause airway blockages and in acute physiological damage, this can cause loss of function. Ice has no impact on swelling, but in the initial stages of physiological inflammation icing can slow this process and limit the loss of function due to the accumulation of swelling. It is much easier for clinicians to stop the loss of function by reducing the accumulation of swelling then to restore function after swelling has set in.

A perfect example of this is when someone has pitting edema which can occur with ankle sprains. In this example when poor immediate care is provided to mediate the inflammatory process the swelling blocks off the lymphatic drainage system and creates a mushy pool of stagnant swollen tissue that restricts ankle function and fluid flow. With acute injury depending on the issue ice is helpful for 48 hours, post 48 hours the inflammatory process ends and the swelling present is now best dealt with by compression. When you see a clinician for an injury we may treat you in a way that strategically re-aggravates the inflammatory response in order to realign the healing process in the way we want. After this we often ice and compress to mediate this response (aka use the Game Ready machine which provides both). If you have chronic swelling, tendonitis or a long term chronic injury then ice will do nothing but provide a pain-killing analgesic similar to what you receive by taking a pain-killing medication.

In regards to the article touching on RICE, this is no longer the acronym used. We prefer to use POLICE for acute injuries which stands for Protect, Optimally Load (use the injury site as much as you can without making it worse or compromising structural integrity), Ice, Compress and Elevate. By not resting and optimally loading we keep the body part moving which helps circulate the blood back to the heart and move the lymphatic drainage system removing the swelling produced by the inflammation process.

As you can see this topic can continue down the rabbit hole forever. But overall this is why we choose to use ice in the clinic. There is no answer that is always right with this topic. For the main contributor of this article to state his opinion as a definitive answer makes me wary of him when he himself states the research is inconsistent. The best anyone can do is to ask their clinician why they are applying ice, if it does not line up with what we touched on then they may be using is incorrectly. Always be an informed customer.

James Greene
BPE, CATA(C), CSCS

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