Is Ice Application Harmful?

Is Ice Application Harmful?

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 building evidence to support this theory (ref) (ref) (ref).  However, in saying that, some of this research has poor statistical significance and has been tested in animals.  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).

ice injury

Could Ice Still Be Beneficial?

Despite the POSSIBLE 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 MAY have a better long term 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 the same as most things 'it depends'.  Despite the new research that supports not icing injuries, there is still an abundance of research to support the opposite.  In most cases it is still general practice to ice acute injuries.  We've been doing it for so long that we know that it can assist in some way.  Future research may help us come to a more definitive conclusion for a more efficient recovery.  In most acute injuries I still recommend the use of ice.

If you decide to not ice an acute injury I would still encourage that you 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!

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