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The truth behind ice and why we still think it’s cool

Estimated Read time: 5 minutes

Please note: Our articles are not designed to replace medical advice. If you have an injury we highly recommend seeing a qualified health professional. To book an appointment with Tim, or one of The Online Physiotherapy team, please visit our Physio clinic page. We have specialists for each major area of the body, ensuring you receive the best treatment for your injury.

Ice Therapy and why we still think it's cool


But is ice really that cool, you might be thinking…

We think so! Keep reading to find out why…

(and how!) you can use ice (cryotherapy) for pain relief and perhaps some other benefits – that we will go through in this post but will not say are gospel!

I’m sure we have all been there, banged your elbow? – go pop an ice pack on it. Perhaps like me you grew up in a frozen peas family?!

Inflammation is a healthy response though, right?

Short answer, yes and no.

So, why are we using ice to reduce inflammation? 

Well, we’re not really… we are actually using ice predominantly as a cheap pain relief, rather than doing much to promote or speed up healing. Yes, it does reduce some inflammation but on balance we have found clinically better results by utilising ice into our rehab in certain scenarios.

Dr Mirkin (the proposer of RICE – rest, ice, compression, elevation, before he debunked ice from the list) actually suggested that ice should be used in small doses early after an injury for pain relief, not necessarily promoting healing.

ankle injury common injury

Considering we can now put people on the moon… why on earth has science not caught up to the point of coming up with something more modern than ice, right? 

I never questioned the use of ice for injuries until my adult life and even now if I ever bash something, an ice pack is the first thing I reach for. So, if you’re in the same club or even if you’re not, (perhaps you just want to know some of the background information) stick with me. Ice is one of those classic, easy, cheap but (most importantly) pretty effective treatment techniques everyone should understand and be able to use to take the edge off the sting of a new injury or ailment. Ice, when used safely and effectively can help to ease pain symptoms and swelling from all finds of injuries, from sprains to tendinitis (you tennis players, I’m looking at you) but it’s pretty much great for any (superficial) tissues that are inflamed and therefore giving you grief.

What does sticking an ice pack on actually achieve?

Ice’s number one job is as an analgesic (pain reliever) and to be honest, science isn’t sure if it does much more than that. All this ‘ice to bring the swelling down’ hasn’t actually got a whole lot of scientific backing… see references for some interesting articles on this. And in addition to this, the prostaglandins are a natural way of your body healing itself – and we want lots of these lovely chemicals so it is a fine balance indeed!

A 2016 study by Vieira Ramos et al. found that it does not slow down healing, as some have jumped on to say that it does.

There are some suggestions that it helps to decrease the body’s inflammation (swelling) response, however, this requires more research before we can take this as FACT! So, simply think of ice as pain relief. I wouldn’t get too caught up in anything else! Although when used in conjunction with ELEVATION (the E in RICE) we achieve that reduction in swelling we’re after.

 

sports person injured leg

What does the science say about ice?

Well, to be honest… there isn’t much conclusive evidence on this – wild, right? I know it’s a bit wishy washy, but it certainly has earned its top spot on the ‘injury port of call’ list due to its known tissue numbing effect – i.e. pain relief!

When shouldn’t you use it is perhaps your next question. The long or short of it is – not the lower back. Icing the lower back can actually aggravate your symptoms – usually because lower back pain is generally not caused by an injury, and more to do with the sensitive soft tissue elements in the area that are covered by lots of layers of soft tissue anyway. On top of that, ice generally isn’t super helpful for chronic (long term) injuries, it’s best for those acute (recent/fresh) injuries; having said that, it can be helpful in some arthritic cases and for repetitive strain injuries such as tennis elbow or tissue fatigue conditions such as carpal tunnel syndrome.

Simply put, until we have more solid evidence, we cannot allow bad research (or no research) to be the foundation for a conclusion on effectiveness, let alone harm. Looking at  acute ankle sprains, the evidence on ice application is ‘inconclusive’ – which is the story from most research on ice. Some suggest marginal improvement with ice + exercise than just exercise (Bleakley et al. 2004) and some state ‘further research required (van den Bekerom et al. 2012). There are no studies done that have found that applying ice after an ankle injury reduces recovery time (Hubbard et al. 2004). In fact, one study showed that early application of ice (< 36 hours) resulted in significantly faster return to play compared to delayed cryotherapy (Hocutt et al. 1982).

How should you use ice following an injury?

Easy, ever heard of RICE? If not I’m about to fill you in anyway – if you have, I have some news for you, RICE has been upgraded to PRICE! This is the suggested protocol for soft tissue injuries in the first 48-72 hours following an injury.

  • Protection – from further injury
  • Rest – avoid any aggravating activity for the initial 48-72 hours after injury
  • Ice – apply ice wrapped in a damp towel for 15–20 minutes every 2–3 hours during the day for the first 48–72 hours following the injury. This should not be left on whilst the person is asleep. Check our this short video for a very cool way on how apply ice for localised injuries, such as tennis elbow! 
  • Compression – an elasticated tubular bandage is a good way to control the swelling following an injury – make sure it’s not too tight and that you take it off at night!
  • Elevation – keep the injuries area up as much as you can to help control the swelling!

When to speak to someone 

It’s always a good idea to touch base with a healthcare professional following a soft tissue injury, we suggest waiting for the bruising and swelling to go down – usually after the first 48 hours. If your injury was on impact and you heard a pop, crack, crunch, ping or you had to stop what you were doing… Nipping to A&E for an X-ray is never a bad idea, just to be on the safe side!

💡 In Conclusion

To conclude, we have learned:

  1. That ice therapy (cryotherapy) is not a fad and can be very effective when used correctly, although mainly for pain relief.
  2. What it can be used for, and what you should usually avoid using ice with.
  3. And finally, how to use it correctly – no ice burns here!

The overarching advice, as with all of our posts, we have just discussed some tips and tricks that might help get you out of pain/set you in the right direction towards getting better. If there is anything you’re seriously concerned about or seriously struggling with please don’t hesitate to get in touch or contact your local healthcare professional. 

If you are in pain, or have an injury book yourself in below to start your recovery today!

References

  1. https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-2001-15656
  2. https://pubmed.ncbi.nlm.nih.gov/15496998/https://pubmed.ncbi.nlm.nih.gov/33877402/
  3. https://pubmed.ncbi.nlm.nih.gov/8896090/
  4. https://cks.nice.org.uk/topics/sprains-strains/management/management/

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