Icing and acute injury management – the latest hot (or cold) topic

Icing and acute injury management – the latest hot (or cold) topic

With the silly season around the corner, some of us may get caught out with a new injury and not be able to seek the help we need in time and left unsure of what to do.

Most are aware of the long-standing acronym of RICE (Rest, Ice, Compression, Elevation) to help us manage our pain, but this has now become outdated for 2 reasons; promoting rest is detrimental and icing may also have a potentially negative response.

What are we doing when we ice the injured area?

Most of what we are changing is skin temperature and nothing deeper. This can slow our nerve activation and calm pain down. In addition to this, it can slow down inflammation, but this may not be favourable long term.

Big bad inflammation always seems to get a bad rap and yet this is a normal response of the body after an acute injury. It helps to bring all the good stuff to the site of injury to initiate the healing process. We need to accept that this will happen and settle down within a few days.

Should we stop the ice all together?

This doesn’t necessarily take the need for ice away. For starters we know it has a great pain-relieving effect and can slow down swelling.

Too much swelling can be detrimental by:

• Reducing muscle activity
• Restricting joint motion
• Increasing pain sensitivity

So, in the cases of profuse swelling (typical in big ankle sprains, ACL rupture or post-surgically), ice is your best friend. In cases where we are not concerned of an inflammatory response and we are using it purely as a pain reliever, this can also be ok.

So should we still be using the RICE principle?

Short answer. No.

What we know is that rest can delay healing, and light loading of the injured area is beneficial!

The most up to date and somewhat convoluted acronym is PEACE & LOVE (Protect, Elevation, Avoid Anti-Inflammatories, Compression, Education & Load, Optimisation, Vascularisation, Exercise).

This clearly takes out the immediate need for icing and rest and aims to promote an active recovery!