Don’t Bother Icing After An Injury?

Recently I was playing beach volleyball, I set my partner for the perfect spike but before he could take off, he snapped his patellar ligament completely in two. Shortly after, many bystanders jump to the scene to help! Inevitably, ice became the hot topic. Haven’t you watched a pro sporting event and seen an injured athlete on the side lines nursing their new injury with some ice? So, it must be really important right?

Well think again, according to research, a 2008 meta-analysis published in the Journal of Emergency Medicine, which examined multiple studies on cold therapy’s effect on acute soft tissue injuries, concluded there is “insufficient evidence to suggest that cryotherapy improves clinical outcome in the management of soft tissue injuries.” Similarly, a 2012 paper published in the Journal of Athletic Training, reviewed multiple, peer-reviewed studies, realized that the practice of using ice to treat sprained ankles “is based largely on anecdotal evidence” and that “evidence from [randomized controlled trials] to support the use of ice in the treatment of acute ankle sprains is limited.” In fact, the patient needs to be careful because ice can diminish reflex activity and motor function, and this can leave someone vulnerable to further injury.

It’s true, Ice is an analgesic. It will numb the area and reduce the pain. It may also slow down circulation temporarily, which is vital for healing? What about RICE? REST, ICE, COMPRESSION, ELEVATION. Actually, the doctor who invented the acronym RICE no longer endorses it. “It’s perfectly fine to ice if you want, but realize it’s delaying healing,” Gabe Mirkin said, “[Icing] is not going to change anything in the long term.” Instead of icing patients might be better off letting it run its natural course. Or get moving again, Mirkin said: “Don’t increase your pain, but you want to move as soon as you can.”

If the pain is tolerable, elevation and gentle massage towards the heart is beneficial. Elevation gives the body the ability to push off unwanted inflammation. Gentle massage is soothing, helps with pain and inflammation. Wait, is inflammation good or bad? Inflammation is initially essential for the damaged tissue. It triggers an entire sequence of healing events for the area of concern. But, early gentle movement has been shown to be more beneficial. Active range of motion works as a pump pushing away unwanted and stagnant inflammation. In 2013, a review of studies on therapies for ankle sprains — which are by far the most common minor injury — by the National Athletic Trainers’ Association gave top marks to such early movement. “By contracting and relaxing a joint, you improve blood flow, which improves healing.” If active range of motion is too painful then immobilizing the area may be indicated.

In review, gentle massage, elevation and slow movements have been shown to be more beneficial in ankle sprains than ice. If you are not sure, to touch base with a health professional such as a Physical Therapist who can help guide you through this healing process! By the way, my volleyball partner is doing a lot better, he knows a great Physical Therapist!

Please call us for your sport injury questions (305) 595-9425.

By Dr. Michael Minder PT, DPT, Kine BSc

Physical Therapist at Orthopedic Rehabilitation Specialists

1. Collins NC Is ice right? Does cryotherapy improve outcome for acute soft tissue injury? Emergency Medicine Journal 2008;25:65-68. 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 3. Domhnall C. Mac Auley. (2001). Ice Therapy: How Good is the Evidence?`. Orthopaedics and Clinical Science. Int J Sports. Vol. 22(5): 379-384. Georg Thieme Verlag Stuttgart · New York. N C Collins. (2008). 4.Mirkin G Why Ice Delays Recovery September 16, 2015. http://www.drmirkin.com/fitness/why-ice-delays-recovery.html 5. Singh DP, Barani Lonbani Z, Woodruff MA, Parker TJ, Steck R and Peake JM (2017) Effects of Topical Icing on Inflammation, Angiogenesis, Revascularization, and Myofiber Regeneration in Skeletal Muscle Following Contusion Injury. Front. Physiol. 8:93. doi: 10.3389/fphys.2017.00093 6. (2013) National Athletic Trainers’ Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes Journal of Athletic Training 2013;48(4):528–545 doi: 10.4085/1062-6050-48.4.02