A recent trip from a family member to the doctor’s office and being told to rest, ice, compress and elevate the injury prompted this blog post…
Should I Ice It?
It is one of the most frequently asked questions I’m asked at Optimum DPT. A summertime hot take…
No.
But that’s heresy you charlatan! When I tweak something, I ice it. Like my father before me and his father before him!
Roll an ankle: Ice it.
Tweak your back: Ice it.
Pull a hammy: Ice it.
Yes, we’re icing folk round these parts and you’re kind isn’t welcome round here!
Hey, I get it. Icing a new injury was still gospel when I was in undergrad studying to be an athletic trainer and later physical therapy school (1999-2007). (Geez time flies.) And, if you or someone you know has played sports in the past 60 years, you’ve likely heard from every physician, therapist, trainer, and coach that icing all injuries is the way to go. You may have even heard of the acronym RICE--Rest, Ice, Compression, Elevation-- is the best thing you can do for your injury.
But why is that?
Well studies from early 1940’s describe that surgeons would use ice to help control pain, lower infection rates, decrease the rate of dying on the operating table.1 This is because ice slows down cellular metabolism, and this allows surgeons to keep as much tissue alive as possible. While ice was intended to preserve lost limbs and decrease surgical complications, it would eventually sneak its way into being used for all injuries.
The key moment for this happened in 1962 when a 12-year-old boy was playing on some train tracks. (That never ends well.) He zigged when he should have zagged, and he lost an arm. But then, for the first time in history, surgeons successfully reattach a whole limb. To preserve the boy’s arm a lot of ice was used.2
This a was major medical milestone, and news story of the successful operation spread. People had lots of questions. Medical jargon answers are hard to remember, but that doctors “iced” the boy’s injured tissue was easy to recall. Public’s take away: any injury needs a good icing. Seems legit. That logic combined with the fact that icing does provide significant pain relief was the foundation for our “ice every injury” mentality.
Fast forward a little more than a decade to 1978. Harvard physician Dr. Gabe Mirkin published the “Sportsmedicine Book” and in created the acronym “RICE” (Rest, Ice, Compression, and Elevation) which was considered the gold standard initial four activities for treating the pain and inflammation of an acute trauma. RICE cemented the concept that icing is THE WAY to go to treat the pain and swelling of a new injury.3
As I said in 2007 icing and RICE was still considered the gold standard… but is it today?
No, we’ve cooled on icing injures (but not on bad puns). And, more come to accept that inflammation isn’t necessarily bad.4
In 2013, Gary Reinl published “Iced! The Illusionary Treatment Option.” In which refuted the RICE protocol, citing numerous research that icing-- while it feels good-- is certainly not beneficial and likely detrimental to a person’s recovery. “It’s actually the worst thing you can do.”
Evidence suggests that icing will:
Prevent the natural flow of oxygen and nutrients via blood circulation.
Trap metabolic waste in and around the injured area.
Potentially cause additional damage to tissues and nerves.
May delay recovery
For most people in pain, anything that takes away the pain (even temporarily) can feel like it’s helping. Since icing can very effectively numb pain, many may think that it too is helping. But in reality, it’s just putting a band-aid on the pain, it’s not actually fixing anything.” 5
Reinl’s argument and supporting evidence was so strong that in 2015 Dr. Mirkin recanted his position and advised people to abandon the RICE protocol he coined.
“Subsequent research shows that rest and ice can actually delay recovery. … the application of cold suppresses the immune responses that start and hasten recovery. Icing does help suppress pain, but athletes are usually far more interested in returning as quickly as possible to the playing field. So, today, RICE is not the preferred treatment for an acute athletic injury.” Reinl, G. (2013). Iced! The Illusionary Treatment Option, 2nd ed. United States of America: G. Reinl
Well, shoot. Now what?
Find out in the next post!
References
1. Massie FM. Refrigeration anesthesia for amputation. Annals of Surgery. 1946;123(5):937-947
2. May 23, 1962: Give That Kid a Hand! | WIRED
3. The R.I.C.E Protocol is a MYTH: A Review and Recommendations – The Sport Journal
4. The Use of Ice For Inflammation: A Prehistoric Approach That Should Be Discontinued