Rebecca Margel | Special to the Fitzhugh
If you’ve ever sprained your ankle, stubbed your toe, or pulled a muscle, you’ve probably been told to put ice on it.
Many of us know the “RICE” acronym, developed by Dr. Gabe Mirkin in 1978, which advises Resting, Icing, Compressing and Elevating injuries as the best way to help reduce swelling.
Dr. Mirkin now recommends starting rehabilitation the day after your injury. He is actively speaking out against the use of ice for the treatment of swelling in acute injury.
Ice can still be an important modality for pain management, but our assumptions that swelling is bad and that ice can reduce it are misguided and not evidence-based.
The most effective way to get inflammatory fluid to return to your circulatory system is not with ice, but with movement. Your muscles serve as a mechanical pump for the fluid that causes swelling.
The act of elevating an injured limb uses gravity to help to drain fluid into your lymph nodes (your lymphatic system is like the vacuum cleaner of the body).
Compression, in the form of a sleeve, brace, tape, or tensor bandage applied correctly (always be careful not to cut off your circulation) can also help.
But ice… in some circumstances ice can actually prolong swelling.
Ice causes the vessels of your circulatory system to constrict, which means that the fluid that wants to return to your circulatory system does so more slowly.
With ice, the fluid within your circulatory system, carrying all the good proteins necessary for healing, will have a harder time moving into the injured area. This can have some short-term effects on healing.
The assumption that swelling is bad is misguided anyway. In acute injuries, swelling is caused by inflammation and that inflammation serves to stop bleeding.
The fluid that is sent to the site of injury, causing the inflammation, protects us from infection.
Clot formation and scar tissue formation depend on the inflammatory phase of healing. Swelling can create painful pressure in our joints, and in an acute injury, inflammatory fluid carries bradykinins which can stimulate a pain response.
Your body is injured and this is an appropriate time to feel pain.
Ice can be an effective pain killer, and acute injuries sometimes hurt a lot. If icing an injury helps you stay off of oral analgesics, or helps with pain adequately to allow you to do your exercises, it’s okay to use it. It just shouldn’t be your primary modality or treatment for acute injury.
Several studies have found that cold compression devices, when used as an analgesic, can reduce patient use of pain medication. While research is limited, it does not appear that using ice as an analgesic will compromise healing in the long term.
A study that looked at muscle injury in mice in 2014, for example, found that at 28 days following injury, tissue healing was the same in both the mice that were treated with ice and those that were not.
In an editorial published in the British Journal of Sports Medicine in 2019, Blaise Dubois and Jean-Francois Esculier of the Running Clinic recommend a new acronym: PEACE and LOVE.
For the first five days following acute injury, patients should Protect, Elevate, Avoid anti-inflammatory modalities, Compress and be Educated about healing times and appropriate exercises for the injured area.
Then, it’s time to Load the injured tissue, cultivate Optimism because our attitudes can impact tissue healing, facilitate Vascularization with cardiovascular exercise, and Exercise.
Your physiotherapist can best direct you to safely load (with weight, resistance, or weight-bearing activities) the injured tissue, educate you to ensure that you understand the stages of healing and expected outcomes, and know how to safely get some cardio in while you work through your rehabilitation.
So next time you sprain your ankle, or stub your toe, or come out of ACL repair surgery, think twice about RICE, and maybe try PEACE and LOVE instead.
Always check with your physiotherapist or doctor for guidance on how to treat an injury. This article is not meant to substitute for medical advice, diagnosis or treatment.
Rebecca Margel is a physiotherapist at Jasper Physiotherapy and Health Centre.
