BLOG: To ICE or not to ICE? that is the question
Physios having been icing injuries for many years and it has been referred to as the gold standard to the RICE protocol, but are things changing?
It’s thought that ice is a great management tool for early and acute injury management by physiotherapists and athletes. The common banded term is RICE and this protocol is widely used by professionals worldwide. It stands for…
Rest - Resting the injury is obvious to make the joint and structures feel more comfortable.
Rice - For 15-20mins every hour is often a prescribed timeframe.
Compression - Provide compression to the injured area with tape or something similar to clingfilm.
Elevation - Raise the injured area above the heart to allow the excess inflammation to drain away.
This process has been recommended during the first 3-4 days, post injury, but is it in line with the latest scientific medical research?
Over the years the protocol has changed from RICE to POLICE…
But even this has been replaced by PEACE and LOVE.
Who would ever have thought that the Optimum blog would ever take on a ‘Woodstock’ vibe!
Optimal loading
The reason for the changes are that medical research had shown that optimal loading, improves healing through cell regeneration induced by light mechanical loading in the early stages. This this may look like a knee brace, crutches or a large supportive boot.
This new physiotherapy knowledge has replaced the ‘rest’ part of the anagram as it is shown optimal loading increases cell regeneration and therefore overall recovery timeframes too.
There is certainly a consensus amongst the physio world that ice is useful in the management of acute injuries. However, literature by (Mirkin, G. (2014, March 16) called ‘Why Ice Delays Recovery’ has shown it to be detrimental for overall acute injury recovery.
In 2019, further research was completed and progressed the anagram to PEACE and LOVE.
What Dr Mirkin is referring to is the necessary benefits of the inflammation process. 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.
Healing process
The other amendments to the anagram are avoiding anti-inflammatories for the exact same reason the ice has. The anti-inflammatories suppress the healing process and the body’s natural release of IGF-1.
So should we still be using ice at all? Something worth considering is in major joint injuries, ACL, lateral ankles and meniscus problems leave us with huge degrees of pain and large amounts of swelling.
If this swelling and pain reduces optimal loading and exercise then it may be important for us physiotherapists to continue with ice application to reduce pain and therefore allow optimal loading.
The early management of injuries plays a huge role in the end outcome and the time it takes to return to full activity.
At Optimum we have physiotherapists and sports therapists available to assess your needs and help plan your recovery and your journey back to the activities you love doing best.
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