The great ice debate

I used to have some bragging rights about my lack of injury and illness throughout the course of my life. But now, I sit here blogging before you on a Friday night with my third acute injury in nine months. I’m not fond of it, I’ll tell you that, but it has been an experience worth documenting in many ways. And in many ways, I will document this experience for you. On my mind tonight is my argument for NOT always using ice on injuries. After slipping off a step in my true clumsy form the other day, I have a pretty solid sprained foot. I’ve also had approximately 13 people tell me to put ice on it. If they only knew that I… have… not… iced… at all.

The RICE therapy (rest, ice, compression, elevation) is a term coined by Dr. Gabe Mirkin in 1978. Coincidentally, this is the year that I was born. I learned the RICE acronym when I was in undergrad studying exercise physiology and when I was in chiropractic school. There was always something about it that never felt right to me and as it turns out, I’m not the only one in this camp. In fact, Dr. Mirkin himself is in the camp. You see, inflammation is the first stage in the healing process. It occurs so that blood can move to the area and begin healing and repairing tissue. If we ice continually, we deprive the injury of that sacred first step and can prolong healing. Ice has the ability to numb an area and take away pain, so a little ice might be beneficial, but it doesn’t likely need to be used with any kind of sustained frequency. A little movement (so long as there is not reason to avoid movement such as a fracture) when possible and some elevation is a more reasonable approach. This will allow for the inflammatory process to take place but move some of the swelling (as in fluid accumulation, not inflammation or heat accumulation) to reduce and circulate out of the area. This has been effective for me personally with a previous knee sprain, wrist fracture and now a foot sprain.

For non-acute injuries, it is also worth discussing if ice should be used. In many cases, heat might trump it. This is especially true of those that are being inhibited by muscle tension. I get a few “are you crazy?” looks when recommending it, so I’ve done my fair share of literature research to be able to back up my advice. Heat can relax an area and increase microcirculation to improve healing. Even those with rheumatoid arthritis can benefit from putting heat on their joints. Each situation should be carefully evaluated because each situation and person is different. But some things to consider are how you feel in the winter cold (tense) versus a hot tub (relaxed). And does an area of pain feel better after you get up and moving or with a hot shower? If so, heat will likely help to resolve the situation. The reason for my advice has more depth than anecdote, but those personal experiences of a patient, student or client can often go a long way. Let that be a vote for using your own intuition and also for using your voice when talking to your healthcare provider.

In summary, ice may not always be the answer. And to keep it clear, I am not suggesting heat or ice is an ALWAYS/NEVER or an EVERYONE/NO ONE kind of thing. But when you can evaluate a situation with clarity, in many cases no ice, or heat versus ice, will do the trick.

Here are a few more articles (with good references) that can help put it into perspective:

Why Ice Delays Recovery

Rice: The End of an Ice Age

RICE: Why We Do Not Recommend It

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