Do I need to ice my injury?

Icing is often the first instinct someone has when they have an injury. Our parents, and even our grandparents have probably always got a cold bag of vegetable out of the freezer any time anyone in the family had a bump or a bruise. From the playing in the playground, to Premier League Football, ice packs will always be the ‘go to’ when it comes to pain relief. But is it necessary?

Over the past century, most injuries have been tackled with the RICE Protocol: Rest, Ice, Compression, and Elevation. Most recently however, many health professionals working in the sporting field have progressed a new protocol, POLICE: Protection, Optimally Loading, Ice, Compression, and Elevation.

What was the reason for this change?

Rest was always the advice given to people after an injury, and unfortunately is still recommended by a lot of physiotherapists and doctors. We know whoever in a lot of cases, that complete rest may make pain reduce, but will often make the injury site stiffer and weaker, therefore rehabilitation will be a longer, more challenging task. Rest has now been replaced by ‘optimally loading’. This means that we always want to keep our patient as active as possible, often staying under a ‘pain threshold’, whereby there is some pain present, but not a significant level to where we’re causing damage.

But what about ice?

There is certainly a consensus throughout the literature that ice acts as a great analgesic (pain numbing agent) by cooling the skin’s temperature. However, the impact on underlying muscles is non-existent, as muscle temperature remains unchanged from topical ice application. Anecdotally (and likely due to the analgesic effect) most people report ice makes injuries “feel better”, at least in the short-term. 

But what impact does immediately icing an injury have in the mid to long-term?

Ice is often sold as an anti-inflammatory, but should we be stopping inflammation? There are some 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.

I will however caveat this with one thing. While some inflammation may be warranted for recovery, too much or prolonged oedema (swelling) is bad news. Excessive oedema applies unwanted pressure on the tissues, restricts movement, can increase pain and decreases muscle function. Therefore, managing inflammation is a balancing act.

So for now, based on the current research, I’d keep ice in the freezer for the most part. As we currently understand it, ice is less important than we once thought. The exception to this rule would be when injuries are severe and in circumstances where swelling will likely be the limiting factor for recovery. In these cases, ice may be beneficial in the early stages only.

What then should be our primary focus?

Encouraging people to return to movement safely again, as soon as it is practical.