Ice has always been thought to help healing but research now says differently

When Gabe Mirkin MD wrote his best-selling Sportsmedicine book in 1978, he coined the term RICE (rest, ice, compression, elevation) for the treatment of athletics injuries. Ice has been a standard treatment for injuries and sore muscles as it helps to relieve pain caused by injured tissue. However, it now appears that both ice and complete rest may actually delay healing, instead of aiding it.

In a study, athletes were told to exercise so intensely that they developed severe muscle damage, which caused extensive muscle soreness.

Although the cooling effect delayed swelling, it did not hasten recovery from the 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.

Healing requires inflammation

When you damage tissue through trauma or develop muscle soreness by exercising intensely, you heal by using your immunity, the same biological mechanisms that you use to kill germs. This is called inflammation. When muscles and other tissues are damaged, your immunity sends the inflammatory cells to the damaged tissue to promote healing.

The response to both infection and tissue damage is the same. The inflammatory cells called macrophages release a hormone called Insulin-like growth factor (IGF-1) into the damaged tissues, which helps muscles and injured parts to heal. However, applying ice to reduce any swelling delays healing by preventing the body from releasing IGF-1.

Applying ice to injured tissue causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation.

The blood vessels do not open again for many hours after the ice is applied. This decreased blood flow can cause the tissue to die and can even cause permanent nerve damage. Anything that reduces your immune response will also delay muscle healing.

Healing is therefore delayed by: cortisone-type drugs, most pain-relieving medicines, immune suppressants, cold packs or ice and anything else that blocks the immune response to injury.

Ice reduces strength, speed, endurance and coordination

Ice is often used as a short-term treatment to help injured athletes resume their sport. The cooling may help to decrease pain, but it interferes with the athlete s strength, speed, endurance and coordination (Sports Med, Nov 28, 2011). In this review, a search of the medical literature found 35 studies on the effects of cooling. Most of the studies used cooling for more than 20 minutes, and most reported that immediately after cooling, there was a decrease in strength, speed, power and agilitybased running. A short re-warming period returned the strength, speed and coordination. The authors recommend that if cooling is done at all to limit swelling, it should be done for less than five minutes, followed by progressive warming prior to returning to activity.

Recommendations

If you are injured, stop exercising immediately. If the pain is severe and you are unable to move, you should be checked to see if you require emergency attention. If possible, elevate the injured part to use gravity to help minimise swelling.

A person experienced in treating sports injuries should determine that no bones are broken and that movement will not increase damage. If the injury is limited to muscles or other soft tissue, a suitably qualified person may apply a compression bandage.

Since applying ice to an injury has been shown to reduce pain, it is acceptable to cool an injured part for short periods soon after the injury occurs. You could apply the ice for up to 10 minutes, remove it for 20 minutes, and repeat the 10-minute application once or twice. There is no reason to apply ice more than six hours after you have injured yourself.

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