Q: Should an acute injury be treated with ice?
A: Research shows that ice will not reduce the healing time of an injury. In fact it will impede the healing process.
In 1978 Dr Gabe Mirkin coined the term “R.I.C.E” the acronym for Rest, Ice, and Compression & Elevation the protocol used for the initial treatment of acute injury. With this protocol being used and taught by first aid trainers, athletic trainers and generally in the medical sphere, over more recent years that has been a lot of debate as to whether ice and rest are advantageous to the healing process. In 2004 and 2013, the American Journal of Sports Medicine published the following studies on the use of ice in injury management.
“In a recent study, athletes were told to exercise so intensely that they developed severe muscle damage that caused extensive muscle soreness. Although cooling delayed swelling, it did not hasten recovery from this muscle damage (The American Journal of Sports Medicine, June 2013). A summary of 22 scientific articles found almost no evidence that ice and compression hastened healing over the use of compression alone, although ice plus exercise may marginally help to heal ankle sprains (The American Journal of Sports Medicine, January, 2004;32(1):251-261).”
Ice is used to restrict blood flow to the injured area “Vascular constriction” thus reducing inflammation and swelling, with the intended result being less damage to the injured area, the result of this however is the body is unable to go through the natural healing process required. During the inflammatory phase the blood entering the injured area is carrying all the required cells and proteins to start the healing process and clean up the debris.
When you damage tissue through trauma or develop muscle soreness by exercising very intensely, you heal by using your immunity, the same biological mechanisms that you use to kill germs. This is called inflammation. When germs get into your body, your immunity sends cells and proteins into the infected area to kill the germs. When muscles and other tissues are damaged, your immunity sends the same inflammatory cells to the damaged tissue to promote healing. The response to both infection and tissue damage is the same. Inflammatory cells rush to injured tissue to start the healing process (Journal of American Academy of Orthopaedic Surgeons, Vol 7, No 5, 1999).
If this inflammatory phase of the healing process is not allowed to run its course the whole healing process may be impeded. This also applies to anti-inflammatory drugs such as Non-steroidal anti-inflammatory drugs, cortisone-type drugs and immune suppressants that are often used to treat arthritis, cancer or psoriasis (Pharmaceuticals, 2010; 3(5)).
Ice can also affect the athlete’s ability when used to reduce pain and swelling during an event, as ice is generally a good pain modulator many athletes use it to reduce swelling and soreness, allowing them to continue with the activity. Ice does not repair the tissue involved it only serves to dull the pain, “a numbing type effect” (slowing nerve conduction) so the athlete may be putting themselves at further risk of injury and a decrease in performance.
Ice is often used as short-term treatment to help injured athletes get back into a game. The cooling may help to decrease pain, but it interferes with the athlete’s strength, speed, endurance and coordination (Sports Med, Nov 28, 2011).
Phases of healing:
As mentioned previously the body needs to go through the whole and correct healing process that is broken down to the following basic steps.
Inflammatory – response Phase, is the process by which the damaged tissue cells result in altered metabolism and liberation of materials that initiate the inflammatory response. During this phase Leukocytes and phagocytes are released through the blood to the injured site to perform a protective task and then clean up the injured site through Phagocytosis (removal of debris) such as damaged cells and bi products. Thus setting the stage for the healing process, without the inflammatory phase the later stages of healing cannot take place.
Fibroblastic – repair phase
The regenerative phase of healing that leads to scar formation and repair of the injured/damaged tissue, at this point the inflammatory symptoms will start to subside. This phase of healing generally starts within a few hours of the injury and may last anywhere from 4 to 6 weeks. Swelling may still be evident at this stage with the area still tender to touch, and some pain on movement.
Maturation – remodelling phase
It is during this phase that realignment of scar tissue (collagen fibres) are aligned to form a tensile strength in the direction of tension. It is important during this phase to use the right rehab techniques to gain maximum benefit and return to activity. This is the longest part of the healing process and depending on the nature and severity of the injury can take from weeks to years.
If not R.I.C.E. What?
This will vary depending on type and severity of the injury and all injuries should be checked by a qualified practitioner. An x-ray or scan may be required to rule out broken bones ETC. In general the following protocol can be followed for soft tissue injuries: Note: the contradiction and use of ice?
Use a compression bandage and elevate the injured area to help the flow of lymph fluid protect the injured area and restrict movement.
If required ice may be used for a short period just to reduce pain with a max period of 10min on then 20min off repeated twice only. “Your doctor may also prescribe pain medication if required”.
During the later stages of the initial Inflammation process and scans have ruled out other complicating factors your therapist can assist with starting the rehab process, usually from 1 to 6 days (depending on severity) with gentle movement within pain tolerance, lymphatic massage and transcutaneous electrical neurological stimulation for pain reduction. At this point some movement is better than total immobilisation as movement will help stimulate the healing process.
Then as the injury moves into the repair and remodelling phase and the swelling and pain decrease more intensive rehab can begin, this will be determined by your therapist.