For this week’s blog, I’d like to talk about the application of ice with injuries in athletics. Within the field of sports medicine the methods by which health professionals help athletes recover and perform at their best is ever changing. I always approach new research with an open mind especially if the science is there to question old habits.
I always see athletes leaving a tournament or game with 3 or 4 bags of ice wrapped on various joints. Many athletes apply habitually just because their coach or parent instructed them to do so because that’s what they have been taught. However recent research behind the science of cryotherapy or applying ice bags for the purpose of injury treatment or overuse injuries has recently come under some scrutiny. Even the physician, Dr. Gabe Mirkin , that coined the term “RICE”, rest, ice, and compression, back in 1978 renounced his findings in 2014 by taking a different approach to how ice is used in the treatment of injuries. Another systematic review of 22 clinical trials concluded that the effectiveness of cryotherapy or use of ice on acute injuries such as muscle strains and contusions has not yet been shown (Bleakley et. al, 2004). Specifically this study found “there was little evidence to suggest that the addition of ice to compression had any significant effect” (Bleakley et. al, 2004). Historically, everyone has been told that applying ice to acute injuries can prevent swelling and aid in the healing process. In the most simplistic terms our bodies start the healing process by breaking down and rebuilding tissue when one applies cold to that area for long periods of time this inhibits the body’s necessary function, so in a sense, we are slowing down these necessary catabolic and anabolic pathways (Huard, et. al, 2002). In order for the body to fully complete that healing process it must release inflammatory cells to that injured area, which release hormones to the injured tissues, which helps muscles and other injured tissues heal (Huard, et. al, 2002). Therefore the application of ice may reduce some swelling initially but it may delay healing by preventing the body from releasing this hormone (Takagi, et. al., 2011).
As an athletic trainer my job is to evaluate each injury and formulate a plan to treat that injury on an individual basis. More often than not I have seen the situation of an athlete having some sort of a nagging/overuse injury that has lingered for weeks and the only thing they have been told to do is ice the area. Ice alone is not going to be a means to the end of the problem and the long term solution is understanding why your athlete is having the problem in the first place. Even the overuse issue can see improvement from a strengthening program by applying appropriate load to that joint or muscle (Khan & Scott, 2009).
This new research does not implicate that ice should never be used but using it more appropriately is the key. The main reason ice can be helpful with acute injuries to aid with pain since cold has an analgesic effect, which reduces someone’s perception of pain (Kennet, et. al, 2007). The cold will numb the area for a period of time but the amount of time to ice should be limited to 10-15 minutes maximum. One should elevate the injury above the heart or as high as tolerable. Then compress the tissue around the joint or injury site from distal to proximal. Once pain has decreased the goal is to start moving that joint or body part through pain free ranges of motions. Movement opens up the lymph channels for the uptake of excessive swelling. Instead of stagnant icing for long periods of time the goal is to open up the lymph channels by moving through a pain-free range of motion as often as you can. If you’re wearing a cast or brace, limiting your motion at that area, move the muscles around that area. Any movement is better than no movement. (Van Den Bekerom et. al, 2012).
There should always be a purpose to everything you do when it comes to treatment. Therefore think about asking yourself why you are applying the ice bag in the first place, is it for pain? Is there swelling in the area where range of motion is limited? Is there bruising or any obvious deformity showing in the area? If you answered yes any of these questions then this problem area needs to be reviewed by a qualified healthcare professional such as a family care physician or orthopedic. There should be some formal diagnosis so that you can formulate a plan to improve the area through rehabilitation and further treatment. Recent research presented in this blog shouldn’t force one to believe ICE has no place in injury treatment but more so to not assume it is the answer every time. The goal should be resolution of the injury and so chronic applications of ice will most likely not be needed.
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Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sport Med. 2004; 32:251–261.
Huard, J., Li, Y., & Fu, F. H. (2002). Muscle injuries and repair: Current trends in research. Journal of Bone and Joint Surgery. 2002; Series A, 84(5), 822-832.
Kennet J, Hardaker N, Hobbs S, Selfe J. Cooling Efficiency of 4 Common Cryotherapeutic Agents. Journal of Athletic Training. 2007;42(3):343-348.
Khan KM, Scott A. Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. British Journal of Sports Medicine, 2009; 43:247-252.
Takagi, Ryo & Fujita, Naoto & Arakawa, Takamitsu & Kawada, Shigeo & Ishii, Naokata & Miki, Akinori. Influence of icing on muscle regeneration after crush injury to skeletal muscles in rats. Journal of applied physiology. 2011; 110. 382-8.
Van Den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM. What is the evidence for rest, ice, compression, and elevation therapy. Journal of Athletic Training. 2012 Jul-Aug;47(4):435-4