People have been perpetuating a myth over the last 50 years that claims ice is an effective treatment for acute soft tissue injuries (e.g.; sprains and strains) because it assists in recovery. The commonly accepted acronym R.I.C.E. – standing for Rest, Ice, Compression and Elevation – has been applied erroneously by athletic trainers and soccer moms alike! If your goal after a soft tissue injury is to heal as fast as possible, using ice is not going to be your best strategy.
The widespread use of ice with the intent to heal soft tissue injuries has no scientific backing, no peer reviewed research. In fact, it has the exact opposite!
In a 2012 article in the British Journal of Sports Medicine called Cooling an Acute Muscle Injury: can basic scientific theory translate into the clinical setting? it was stated: “ice is commonly used after acute muscle strains, but there are not clinical studies of its effectiveness.”
The Journal of Emergency Medicine published a study in February 2008 entitled: Is ice right? Does cryotherapy improve outcome for acute soft tissue injury? The research concluded that “there is insufficient evidence to suggest that cryotherapy [i.e. icing] improves clinical outcome in the management of soft tissue injuries.”
If those two didn’t solidify the argument in your mind, check out this last study entitled Topical Cooling (Icing) Delays Recovery from Eccentric Exercise Induced Muscle Damage from the May 2013 edition from the Journal of Strength and Conditioning Research. It was found that “topical cooling [i.e. icing], a commonly used intervention appears to not improve but rather delay recovery from eccentric exercise induced muscle damage.”
With such surmountable evidence against the case of icing post injury, one will wonder why the application of ice has been so pervasive over the last 50 years. My thought is that since it does numb the nerves around the injury, thereby decreasing the pain, this perpetuates the myth. However, as the research has stated above it dos not help with the recovery process and has been shown to effectively slow down the healing process as the cooling mechanism causes blood vessels to constrict. This constriction keeps the swelling and inflammation – the crux of the body’s healing response, brining more immune activity to a place of injury – from doing its job properly by slowing down the process and dragging out the painful swelling and inflammation.
So if icing is wrong, what can we do to properly treat acute soft tissue injuries? We will need a new acronym or MECHanism to address this situation properly…
Move. Elevate. Compress. Heat. (and never ice symptoms anymore)
Movement of the affected body part prevents the formation of adhesions and increases circulation which transport in nutrients and carries away metabolic waste. Moving allows the body to lay down new tissue along the lines of stress or normal ranges of motion. In contrast, the old suggestion of Rest causes tissue to be laid down in a disorganized pattern resulting in poor function and reducing ranges of motion. Whether your movement is an active or passive range of motion activity or manual manipulation of tissues it will stimulate the nerves that communicate pain inhibition to the brain. Think of the time when you fell and skinned your knee and your mother rubbed the area and it magically felt better, this is the idea behind movement. A TENS unit will also facility movement in an elevated position.
Elevate the injured area above the heart to increase the circulation of swelling and inflammation away from the injured area. Most likely you will be sitting while elevating the area but should still make an effort to move. An example would be if it is an ankle sprain, think about moving it up and down, side to side, and clockwise and counter-clockwise. If it is a groin or larger muscle strain, think about applying a TENS unit to stimulate movement of the tissues.
Compress with an ACE bandage to facilitate increased circulation. Pair movement with compression.
Heat augments the benefits of movement by causing the blood vessels to open up, or vasodilate, which increases the movement of swelling and inflammation away from damaged tissue and promotes the introduction of white blood cells and other healing mechanisms to the area.