Over the years we've become accustomed to hearing 'put ice on it' anytime we injure ourselves. After someone suffers an injury I often hear "should I use ice or heat?". Unfortunately the answer is, it depends and the rationale is complex.
For as long as I can remember the household acronym for acute injury management has been R.I.C.E . It stands for Rest, Ice, Compression and Elevation. The combination of these four things is what is generally prescribed as the preferred way to manage an acute injury. The justification for using ice is generally for pain relief. Most of us who have tried it can say with confidence that it is effective at reducing the pain. There is even clinical research that shows it is effective at doing this (ref).
But, this isn't the only effect cold application has. We often also hear that it plays a large role in preventing swelling as well.
Should We Eliminate Swelling?
The immediate need to eliminate swelling post injury has always puzzled me. Why are we doing this? What will reducing the swelling do? After all, we know that many of the cells that rush to the area of swelling play a vital role in recovery during the inflammation process.
Over the past few years there are been an increasing amount of momentum behind the idea that reduction of swelling via ice may lead to decreased healing times and poor quality of recovery. This could mean a prolonged return to sport or increased risk of re-injury.
There is a number of building evidence to support this theory (ref) (ref) (ref). One study in particular found that it led to reduced macrophages, both reduced and smaller sized regenerating muscle cells; They also found evidence of abnormal collagen formation (ref).
Could Ice Ever Be Beneficial?
Despite the negative effects discussed there are still situations when icing an acute injury may be beneficial. For example, let's say that you're an elite athlete. You have the most important competition of your life coming up and you tear a muscle in your shoulder, what will you do? If you avoid icing it you now know that you'll have a better recovery. But, the pain you're experiencing may limit your function and ability to train leading up to the competition. This could cost you greatly, at a time like this you may consider ice so you can continue to train and prepare for the competition.
You may also use it to settle anxiety as a psychological win. Many people will gain comfort in the fact that they are taking some sort of action to improve their injury. Although recovery might not be optimal the trade off might be worth it if it reduces stress levels associated with the injury.
So Should I Use Ice?
Well, in general it looks like the answer is no. But, as stated at the start of this article it really does depend. Whether you should use ice or not will come down to the goal that you're trying to achieve. That is the question you will need to ask yourself.
In light of the recent research I personally tend not to recommend ice for acute injuries under most circumstances. When not icing acute injuries I believe that you should follow the other principles of R.I.C.E with the exclusion of 'Ice'.
For the first 72 hours following injury: Still carry on 'Rest'ing from strenuous activity, gentle light movements are generally alright. 'Compress' with a compression bandage, being careful with not applying it too tight that you cut off circulation and last but not least 'Elevate' where possible. This prevents excess fluid and inflammation from accumulating in the injured area. Examples include placing your feet up on a stool for a lower limb injury or elevating your arm by propping it up with some pillows or cushions for an upper limb injury.
If symptoms persist following this, see your local General Practitioner or Physiotherapist for further assessment or treatment and rehabilitation. This will ensure that you have a speedy recovery!