THE EVIDENCE BEHIND ICE – PART II

This is the second part  of ‘The Evidence Behind Ice’ post from guest blogger Craig Donovan. Craig studied physiotherapy at Curtin University and is currently working in a rural hospital setting. He has a strong interest in research, particularly in the areas of pain and neurology. After recently completing a project looking into the association between the brain and pain, he is a strong believer in the importance of the brain in pain control. If you missed out on the first post, check it out here: The Evidence Behind Ice – Part I.

After many years of complying with the RICE principal it has become so heavily ingrained into our brains that, when injured, we reach for the closest bag of peas and rest for a few days. This is something that is controversial, but has to stop.

Research has shown there is very little evidence that, ice plus compression vs compression alone, speeds up the healing process. There is strong evidence for the use of compression to assist in decreasing secondary swelling. Ice still plays a role in acute injuries, but only to aid in decreasing the pain by numbing the area. Therefore it is best used sparsely and for no more than 10 minutes at a time. But be aware: if you intend to continue playing sport after icing, ensure that a thorough warm up is completed as ice has been shown to reduce endurance, speed, coordination and strength of muscles.

The most recent evidence points towards elevation as being the key component in promoting early recovery. This is because the inflammatory cells have reached the target tissue but require aid in terms of drainage from the area, preventing secondary cell death (something ice does not).

Another key component that I suggest in the early stages of recovery is gentle movement (within pain limits), as this assists to both bring fresh blood into the area and also facilitate drainage through the muscular pump system. Just think about how much swelling there is following surgeries such as knee and hip replacements…. the surgeons orders are always for early mobilisation, as immobilisation leads to further complications.

If the injury is severely painful and there is an inability to move or weight bear through the injured area, then stop whatever activity you are doing. If in doubt, always consult a medical professional for further opinion, especially to rule out broken or fractured bones which, if  undiagnosed, can lead to lengthy recoveries. Physiotherapists are great at designing exercise programs to target the affected area and assist in a quicker return to sport.

So in summary, let the body do what it has been designed to do and heal itself, avoid both ice and anti-inflammatories. The body allows us to perceive pain for a reason – to make us aware that an area is injured and needs healing. The initial management is just as important (if not more) than the rehab later down the track. Aim to return to function as early as possible without pain.

Please share your thoughts or questions below.

By Craig Donovan

 

References:
http://www.chiro.org/LINKS/FULL/Immobilization_or_Early_Mobilization.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396304/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC522152/

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2 thoughts on “THE EVIDENCE BEHIND ICE – PART II

  1. I have never once used ice in a situation and told anyone that the ice was designed to heal the injury. The inflammatory process is essential to healing, however, excess swelling and/or inflammation can create an environment in the body that may not be beneficial to the healing process. Ice is merely an additional tool to create an optimal healing environment, not to heal the injury. Early movement and use of the joint is also crucial in creating an optimal healing environment to help flush excess inhibitory chemicals. At not point do I recommend applying ice and then returning an athlete to play.

    1. Hi Jason,
      I agree completely that ice still is a useful tool, however too often it is said to reduce swelling and therefore inflammation. In reality, it’s benefits are centred on the pain relief it achieves, promoting early movement as you pointed out.

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