When you sprain an ankle or pull a hamstring, one of the first things you might do is find an ice pack.
Because that is what we have been told to do and it has been the sports medicine recommendation for decades. The ‘RICE’ (Rest, Ice, Compression, Elevation) acronym has been used for over 40 years and was created by a Doctor of sports medicine; Dr Gabe Mirkin (The Sports Medicine book, 1978).
In 2012, a study was published that analyzed the effect of ‘RICE’ therapy in ankle sprains which revealed a massive lack of evidence supporting this type of management. In his 2013 book, ‘ICED! The illusionary treatment option’, Gary Reinl suggests the idea stemmed from a horrible accident way back in 1962. A 12-year-old boy had his right arm completely torn from his body while boarding a freight train. His severed arm was kept on ice, a tourniquet was placed on the area to prevent further blood loss and he was told to keep calm and rest –starting to sound familiar? This was the first successful reattachment of a limb. So somehow the action plan for a severed limb was adapted to the acute management of any soft tissue injury to help with the body’s healing process
“BOTH ICE AND REST MAY DELAY HEALING INSTEAD OF HELPING”
Dr Gabe Mirkin then changed his mind and wrote in 2015, that “…both ice and rest may delay healing, instead of helping”. More recent studies have found that the use of ice compared to not using ice have absolutely no superior effects at all!
So why should we rethink the use of ice after we hurt ourselves?
Let’s start with the two main reasons why we do:
1.To reduce inflammation/swelling and
2.To reduce pain
The two stages of the body’s natural healing process:
1.Inflammation(a by-product of this is swelling)
We need to remember one important thing: healing CANNOT happen without inflammation. It is not a bad thing, it’s just a thing that has to happen. By adding ice, this will restrict blood flow which carry the healing properties that kick off inflammation! Hence, we are simply just delaying something that is going to need to happen sooner or later, so why not sooner? Similarly, pain serves a valuable purpose, giving us important feedback about whether we are doing too much or too little to help the injury. Your body is smart, and although not pleasant, these pain signals are your brain telling you you’re probably in dangerous territory.
“HEALING CANNOT HAPPEN WITHOUT INFLAMMATION”
By shifting our perspective of seeing these things as bad we can acknowledge that we really do need these steps to happen for our body to do its healing magic! Side note, here are some other things that can negatively affect the healing process:
-Continued trauma (e.g. pushing through pain)
-Sleep (quality and quantity)
So what do we do instead?
In 2019, a new acronym was proposed that accounts for all stages of an injury and is aimed at optimizing recovery – PEACE & LOVE.
Immediately after an injury, give the injury some PEACE. Then after a few days, the injury needs LOVE.
In summary, there is now a new response to managing a soft tissue injury that should be implemented, and ice is not the way to speed up healing if this is your goal. However, there will be occasions that ice may be appropriate. For example, if an injury occurs during a grandfinal, ice and anti-inflammatories could be used to relieve pain and limit the swelling, so the athlete has a chance to participate in the rest of the game. The use of ice isn’t bad, it just depends on what your goals are immediately after injury occurs.