To Ice or Not to Ice? That is the Question

Most of us are familiar with the acronym RICE when it comes to athletic injuries: Rest, Ice, Compression, Elevation. This was an idea engrained in my mind as a method to best treat the acute stages of inflammation in an injury for as long as I can remember. One of the most common phrases heard in athletic training rooms around the country is “Throw some ice on it”. But what if this practice that has become such a standard in acute management of injuries isn’t actually beneficial?

Most individuals who have suffered a musculoskeletal injury have used cryotherapy in one form or another to manage the injury. If the reason you’re icing is for pain or soreness, ice has been repeatedly shown to be effective, no matter what form: ice bag, ice bath, cold whirpool, etc. Many of us have heard that we should put ice on injured areas to reduce inflammation. There is a large debate on whether or not this is actually effective. Some studies have shown that there’s actually not a change in blood flow to muscle after cryotherapy treatment even though there was a decrease in temperature¹, which would promote the idea that inflammation can’t be changed if there’s not a change in blood flow. This leads to another thought: even if cryotherapy was effective in reducing blood flow, would you want to reduce the inflammation that brings healing agents to body parts that need to begin the healing process? On the flip side, another recent study² in rats has shown that although icing reduced the inflammatory response, it did not inhibit the muscle regeneration that occurred afterwards.

For now, in my clinical practice, I will continue to use ice for this reason: 99% of individuals come to me because something hurts, and ice is very effective in pain management. I will, however, be more aware of my reasons for icing and look for alternative methods to treat symptoms that cryotherapy has long been believed to be effective treating.

-Chip

1.       Selkow NM Day C Liu Z Hart JM Hertel J Saliba SA. Microvascular perfusion and intramuscular temperature of the calf during cooling. Med Sci Sports Exerc. 2012;44(5):850-856.

2.       Vieria RG, Pinheiro CM,  Messa SP, Delfino GB, Marqueti Rde C, Salvini Tde F, Durigan JL. Cryotherapy Reduces Inflammatory Response Without Altering Muscle Regeneration Process and Extracellular Matrix Remodeling of Rat Muscle. Sci Rep. 2016 Jan 4;6:18525.